Vascular_2 Flashcards
Name for a localised round atrophic regions surrounded by dilated capillaries, typically caused by deep venous insufficiency
Atrophie Blanche
Causes (2) of deep venous insufficiency
- DVT
- valvular insufficiency
Characteristics (3) of the failure of venous system
- venous hypertension
- obstruction
- valvular reflex
What’s the difference between Deep Venous Insufficiency and Varicose Veins?
Deep venous insufficiency -> affects deep venous system
Varicose veins -> affects superficial veins
Symptoms of Deep Venous Insufficiency
- chronically swollen limbs
- pruritis
- pain/ache
- bruises
- tightness on walking -> resolves with leg elevation
Signs of Deep Venous Insufficiency
- pedal oedema
- varicose eczema -> dry and scaly skin
- thrombophlebitis
- skin staining
- lipodermatosclerosis
- atrophie blanche
- possibly venous ulcers (usually around median malleolus)
Symptoms of Post Thrombotic Syndrome
Post Thrombotic Syndrome (post-DVT)
- heaviness
- cramps
- pain
- pruritis
- paraesthesia
- pretibial oedema
- skin hyperpigmentation, induration
- venous ectasia
- redness and ulceration
What scale is used to monitor degree of Post-Thrombotic Syndrome?
Villalta Scale
Management of Deep Venous Insufficiency
- compression stocking
- analgesia
- 4 layer bandaging -> if ulcer developed
- elevating the feet above the level of the heart
*surgery - little effective
if symptoms worsen -> surgery may help a little
Surgery: valvuloplasty, venous stenting (if post-thrombotic syndrome)
What 3 factors influence blood flow through the vessel?
- viscosity
- radius
- length
How do the length and viscosity influence the blood flow through the vessel if it’s x2?
blood flow will be / (decreased) by 2
If the radius of the vessel is halved (50% less) how would it influence the blood flow through that vessel?
Blood flow will be divided by 16 (16 less)
Why can we hear the bruit?
There will be narrowing -> turbulent blood flow at the point of atherosclerosis
What happens when there is 50% of occlusion of the artery lumen?
What happens when there is 70%?
Changes start at 50% -> reduction of radious of the vessel
70% -> critical stenosis
What’s DSA?
- Digital Subtraction Angiography*
- fluoroscopy technique used to clearly visualise blood vessels, bones or soft tissues
- contrast medium used to visualise the structure
Use in the diagnosis of arterial/venous occlusions, arterial stenosis, PE, to diagnose renal artery stenosis (standard procedure in donations), aneurysms, AVM
How to calculate ABPI?
ABPI= Pressure leg/Pressure arm
- systolic pressures only are considered
- the higher pressure in arm is considered -> stays same for both legs (arm pressure same; but legs need to measure up separately)
- done with doppler -> instead of stethoscope (listen when the sound appears and disappears)
What if ABPI is above 1.0 e.g. 1.2?
That’s a false high
- happens in e.g. DM (as the vessels are calcified so higher pressure needed to detect it)
What to do (initial management) if the following values are there at ABPI?
- >1.2
- 0.9 - 1.2
- 0.8 - 0.9
- 0.5 - 0.8
- <0.5
- >1.2 refer to vascular surgeon
- 0.9 - 1.2 normal
- 0.8 - 0.9 some artificial disease -> Mx risk factors
- 0.5 - 0.8 moderate arterial disease -> refer to specialist routinely
- <0.5 severe disease -> urgent referral
What ABPI ranges TED stocking is used for?
- Less than 0.8 — compression stockings are contraindicated, as severe arterial insufficiency is likely. Refer the person for specialist vascular assessment.
- Between 0.8 and 1.3 — compression stockings are safe to wear.
- Greater than 1.3 — avoid compression, as high ABPI values may be due to calcified and incompressible arteries. Refer the person for specialist vascular assessment.
What’s post-thrombotic syndrome?
- long-term complication of DVT
- vessel affected by thrombosis -> valve is damaged (by inflammation and thrombus pressure is increased -> superficial vein rupture)
- symptoms: pain, swelling, discoloration, and even ulceration
What’s responsible for colour changes around venous ulcer?
deposits of haemosiderin (a breakdown product of RBC) in the skin
What causes an inverted champagne bottle appearance in the venous ulcers?
healing and fibrosis
* as there is enough blood flow into the wound (in venous) -> that’s why also venus is known to have ‘slopping edge’ (as some areas are healed)
Why arterial/ neuropathic ulcers are known to have ‘punched out’ appearance?
The blood flow to the wound will be decreased (as arterial disease) -> healing is impaired
What’s VAC?
Vaccum-Assisted Closure of Wound
- the device decreases pressures that naturally occur in the air gases on the wound
- it encourages wound healing, the growth of new tissue
Use: wounds after skin grafts, chronic, non-healing wounds
What’s the appropriate angle we hold a Doppler probe at?
60 degrees
*hold it like a pen
What causes tapering/reducement of the legs above the ankles (“inverted champagne bottle”)
lipodermatosclerosis
What happens in varicose veins? (pathophysiology)
Valvular incompetence -> blood from deep venous system -> into superficial venous system -> venous hypertension and dilation of superficial veins
Gold standard investigation for suspected varicose vein
Duplex ultrasound
Characteristic location for venus ulcer
Median malleolus
