Vessels of the Lower Limb

Question 1

where is the femoral artery?

Answer 1

it is superficial in the femoral triangle, it is easily accessed

Question 2

why might access to femoral artery be required?

Answer 2

to obtain ABG in emergencies if poor peripheral pulses or for minimally invasive procedures (coronary angioplasty, coronary angiography, embolisation in berry aneurysms)

Question 3

what are the borders of the inguinal triangle?

Answer 3

sartorius laterally, adductor longus medially and superiorly the inguinal ligament

Question 4

where does the great saphenous vein lie?

Answer 4

immediately infront of the medial malleolus - obtain IV access in emergencies

Question 5

what is LL ischaemia most commonly caused by?

Answer 5

atherosclerotic disease - causes chronic ischaemia gradually

Question 6

what is ischaemia?

Answer 6

the inability of perfusion to meet the demands of the tissue meaning that hypoxia and anaerobic metabolism results - tissue damage

Question 7

what is acute ischaemia?

Answer 7

sudden loss of perfusion to the limb usually from occlusive thrombus or embolus in artery but can also occur secondary to trauma

Question 8

what is atherosclerosis?

Answer 8

it is a disease process - lipids are deposited in lesions in the walls of larger arteries - plaques will partially occlude the artery

Question 9

what happens if inflammation continues?

Answer 9

they become unstable and rupture

Question 10

which arteries does atherosclerosis affect?

Answer 10

medium and large conduit arteries, where there is turbulent blood flow at birfurcation points and usually carotid, lower limb, coronary and aorta

Question 11

what does the fibrous cap of atheroma comprise?

Answer 11

smooth muscles and collagen - necrotic cell debris and cholesterol are inside

Question 12

what causes an acute iscahemic event?

Answer 12

plaque rupture - the core is exposed to blood and is also highly thrombogenic, therefore platelet aggregation and activation of the coagulation cascade occur. A thrombus is formed lodging and occluding artery or embolus breaks off and lodges in smaller vessel

Question 13

what are the stages of the fontaine classification of limb ischaemia?

Answer 13

asymptomatic, intermittent claudication, ischaemic rest pain and finally ulceration and gangrene signalling critical ischaemia

Question 14

what are signs of critical ischaemia?

Answer 14

foot pain at rest, ulceration or gangrene

Question 15

what is dry gangrene?

Answer 15

it is tissue necrosis without infection and often occurs in chronic ischaemia as the lack of blood means lack of oxygen and glucose meaning bacteria cannot grow - starts at toes and appear black, dry and shrunken

Question 16

what is wet gangrene?

Answer 16

tissue necrosis and infection - appears black, soft and putrid and can quickly lead to sepsis and death

Question 17

what are the symptoms and signs of acute limb ischaemia?

Answer 17

6 Ps:
pallor
pain 
paralysis 
paraesthesia 
poikliothermia 
pulse deficit

Question 18

what are varicose veins?

Answer 18

they are increased pressure in the saphenous veins that can be caused by proximal venous obstruction - veins become dilated and incompetent - blood stagnates in the skin leading to breakdown and ulceration

Question 19

what are complications of varicose veins?

Answer 19

superficial thrombophelbitis, bleeding and varicose veins down medial ankle, dermatitis or skin thickening

Question 20

what is dvt?

Answer 20

deep vein thrombosis - it is a thrombus in the deep veins of the leg or pelvis that is warm, swollen, red or painful and tender on examination

Question 21

what are complications of DVT?

Answer 21

clot can break off from vein wall and lodge in lungs - PE

Question 22

what are risk factors for DVT?

Answer 22

malignancy, pregnancy, sepsis, IV drug use, immobility, fracture or surgery previous VTE