Vascular Tree

Question 1

What provides most of the size change in artery wall thickness?

Answer 1

Large tunica media

Contains a lot of elastin

Question 2

What Innermost layer?

Answer 2

Factory produces proteins and receptors that serve as vascular processes and help the vessel respond to stimuli

Question 3

What is the Vasa Vasorum?

Answer 3

Vessels that supplies the tunica of large vessels with nutrients and blood.

Question 4

What is an anastamoses?

Answer 4

Where arteries communicate with each other

Question 5

What is collateral circulation?

Answer 5

Expansion of anastomoses resulting in extensive network
Important, as one artery may become blocked, and this will allow for alternate circulation (although likely lower volumes)

Question 6

What are the major vessels/veins within the groin, moving medial to lateral?

Answer 6

Lymph most medial 
Femoral Vein medial
Femoral artery more lateral
Femoral nerve more laterally
(NAVL)

Question 7

How does the femoral artery change as it moves distally?

Answer 7

Femoral -> moves posteriorly through adductor hiatus of adductus magnus forming the popliteal artery -> popliteal carries through popliteal fossa then bifurcates into the anterior tibial artery and the common trunk of the posterior tibial and peroneal arteries

Question 8

What are the divisions of the femoral artery?

Answer 8

Popliteal Artery (divides into AT and PT)
Anterior Tibial Artery
Posterior Tibial Artery
Peroneal Artery (aka fibular)

Question 9

How does the posterior tibial artery move throughout the foot?

Answer 9

Posterior tibial artery comes to medial angle and feeds plantar arch running along base (underneath) of metatarsals.
Gives rise to calcaneal, and medial/lateral plantar branches.

Question 10

What does the pulse represent?

Answer 10

Palpable arterial pressure after each heartbeat

Question 11

What are the main pulses we examine?

Answer 11

Carotid, brachial, radio/ulnar, femoral, posterior tibial (medial aspect of ankle), popliteal (above posterior knee), dorsal pedis

Question 12

What are the upper limb pulses we can examine on ourselves?

Answer 12

Axillary (inferiorly on lateral wall of axilla)
Brachial (medial aspect of arm near elbow)
Radial
Ulnar
Carotid pulse

Question 13

What is the ABPI

Answer 13

Ankle Brachial Pressure Index- checking for Peripheral Artery Disease
Comparison of blood pressure of upper and lower limbs.
Arms tend to be spared from impacts of atherosclerosis, which gives us a normal reference point for comparison
Normal >1
mild PAD 0.7-0.9
moderate 0.5- 0.7
severe PAD 0.3-0.5
Limb threat <0.3

Question 14

What are exceptions to the Ankle Brachial Pressure Index test?

Answer 14

Calcified vessels don’t compress and can give false ABPI when looking to diagnose peripheral artery disease

Question 15

What is Buerger’s test?

Answer 15

Differences in colour of limbs
Red feet can result due to loss of vasoconstrictive abilities because of ischemia. Vessels are in chronic vasodilated state, giving red appearance.
This should disappear when removing gravity (i.e. lift foot in Buerger’s test)

Question 16

What pulse can be visualized on the abdomen?

Answer 16

Aorta
Palpated just above the belly button
If aneurism is present, swelling is typically observable- can palpate on either side to estimate size

Question 17

Where is the iliac artery pulse typically found?

Answer 17

Iliac pulses are only typically felt if patient is very thin or if they are aneurismal
Found medial to ASIS

Question 18

During palpation, where is the femoral artery typically found?

Answer 18

Femoral easily found in groin
Hard in obese patient, or weak patients. May need to use bony landmarks (pubic tubercle, and iliac spine help find ligament where vessel is just medial too)

Question 19

How is the popliteal artery typically found?

Answer 19

Locate popliteal fossa, have patient relaxed with few degrees of flexion, apply pressure until pulsation is felt.
Can apply pressure using thumb at anterior knee to help

Question 20

What signs are observed in patients with chronic lower limb ischemia

Answer 20

Skin is thin/shiny/scaly
May be dark red in colour, lack of hair, skin necrosis/gangrene, slow growing nails with ridges/weakness
Check for ulceration between toes and on heels
Colour changes (use Buerger’s test- should produce pallor if patient is ischemic- for patients of colour, look for swelling as colour change may not be notable)
Temp is not reliable

Question 21

Is the brachial pulse present in all patients?

Answer 21

Brachial pulse is absent of 40% of people

Question 22

What is atherosclerosis?

Answer 22

Calcification and plaque formation of vessel wall
Most common arterial disease
Elasticity loss
Increase in foam cells (macrophage) and fatty streaks

Question 23

What are the major components of plaque?

Answer 23

Cells- macrophage foam cells,

ECM- collagen, elastin

Question 24

How does atherosclerotic plaque form?

Answer 24

Begins in teenage years, fatty streak development ->
Stable angina, claudication, and PAD -> MI/unstable angina, stroke, critical limb
Steps:
1) endothelial dysfunction
2) formation of lipid layer or fatty streak within the intima
3) migration of leukocytes and smooth muscle cells into the vessel wall
4) foam cell formation
5) degradation of extracellular matrix

Question 25

What is intermittent claudication?

Answer 25

Leg angina
Exertional leg pain, typically in calf, relieved by rest
Better outcomes in legs as opposed to systemic outcomes

Question 26

What is endarterectomy?

Answer 26

Opening an artery to remove plaque/disease

Question 27

What is an embolism?

Answer 27

Blockage of a blood vessel by solid, liquid, or gas that has moved to a distant location from its origin