Week 3 - Peripheral Vascular Disease

Question 1

What is the main cause of Peripheral Artery Disease

Answer 1

Atherosclerotic disease of the arteries that perfuse the limbs (especially the lower extremities)

Question 2

What are the consequences of a thrombus forming over an atherosclerotic lesion?

Answer 2

If a thrombus forms over the atherosclerotic lesion, blood flow can be abruptly blocked. This can cause severe pain, loss of pulses, and changes in skin color.

Question 3

What are the treatments for Peripheral Artery Disease

Answer 3

• Risk factor reduction such smoking cessation and treatment of diabetes
• Antiplatelet therapy
• Symptomatic PAD: vasodilators + antiplatelet or antithrombotic medications
• Acute symptoms: percutaneous or surgical revascularisation

Question 4

Why are Venous Thrombi more common than Arterial Thrombi

Answer 4

Due to the flow and pressure being lower in the veins than in the arteries

Question 5

What are examples of Venous Thrombi

Answer 5

• Deep vein thrombosis (DVT): primarily in the lower extremities
• Pulmonary embolism

Question 6

What are risk factors of Venous Thrombi

Answer 6

1. Venous stasis
   - e.g. immobility
   - age
   - heart failure
2. Venous endothelial damage
   - e.g. trauma
   - medications
3. Hypercoagulable states
   - e.g. inherited disorders
   - malignancy
   - pregnancy

Question 7

What are the management for Venous Thromboembolus

Answer 7

• Prevention is important in at-risk individuals (e.g. mobilisation)
• Pharmacological therapies (anticoagulants) - Heparin, Warfarin
  and Rivoroxoban
• Graduated compression stockings
• Mechanical devices (e.g. ‘calf compressor’)
• Early ambulation (walking around): facilitates blood flow and decreases venous stasis

Question 8

Define Varicose Veins

Answer 8

Avein in which blood has pooled, producing distended, tortuous and palpable vessels.

Question 9

Define the structure of a normal vein

Answer 9

• Thin-walled
• Highly distensible vessels
• Has valves to prevent backflow and pooling of blood

Question 10

What is the pathophysiology of Varicose Veins

Answer 10

• Valve damage → Leads to blood pooling in the vein.
• Vein becomes engorged with blood.
• Chronic venous insufficiency develops due to inadequate venous return over time.
• Circulatory stasis and tissue hypoxia occur.
• Inflammatory reaction in blood vessels.
• Fibrosclerotic remodeling of the skin and ulceration may develop.
• Oedema can extend up to the knees.

Question 11

What are the risk factors of Varicose Veins

Answer 11

• Can develop over time when diminishes the action of the skeletal muscle pump (which assists venous return).
• Habitually stand for long periods
• Wear constricting garments
• Cross their legs at the knees

Question 12

What does Varicose Veins increase the risk of?

Answer 12

• Deep vein thrombosis
• Skin hyperpigmentation
• Stasis ulcers