11. Peripheral arterial and venous disease Flashcards Preview

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Flashcards in 11. Peripheral arterial and venous disease Deck (18)
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what is the relationship between superficial and deep peripheral veins

superficial veins (within subcutaneous tissue) drain into deep veins (within muscle) via perforating veins which pierce deep fascia


what is the one constant vein in the body

the long saphenous vein anterior to the medial malleolus


how is blood in peripheral venous system moved against gravity to heart

1. muscular contractions within tight deep fascial compartment compress veins - i.e. calf pump

2. valves to prevent back flow


what is the pathophysiology behind varicose veins

vein wall weakness... vein dilation and separation of valve cusps... valves become incompetent.


what are the symptoms of varicose veins

- heaviness and tension
- aching
- itching (histamine release)
Along the vein itself


what are the possible direct and indirect complications of varicose veins

Direct from vein itself:
- haemorrhage
- thrombophlebitis

Indirect due to venous hypertension:
- peripheral oedema
- venous ulceration
- skin pigmentation
- varicose eczema
- lipodermatosclerosis (hardening of fat)


what is thrombophlebitis

inflammatory process causing blood clot formation and obstruction of a vein - can be superficial or deep, i.e. deep vein thrombosis


explain the causes of venous hypertension

Is a result of calf muscle pump failure, itself due to:

1. failure of calf muscle contraction - immobility, obesity, reduced hip, knee or ankle movement
2. deep vein incompetence (congenital)
3. volume overload - superficial vein incompetence (causes increased blood flow into calf muscle pump via perforating veins rather than blood entering deep veins higher up)


name the 3 components of Virchow's triad. which is most important in venous thrombosis or in arterial thrombosis

1. hypercoagulability
2. change in blood flow, i.e. stasis - most important in venous thrombosis
3. change in vessel lining, i.e. blood vessel damage - most important in arterial thrombosis


where does DVT most commonly develop

deep calf veins


what are the signs and symptoms of DVT

symptoms (not always present!):
i. pain (can't walk)
ii. swelling

i. calf tenderness
ii. muscle induration
iii. blue-red skin discoloration, warmth, distended superficial veins
iv. oedema
v. pyrexia


what is acute limb ischaemia and when does it become irreversible

- Sudden onset obstruction of blood supply to a limb - no chance for collateral vessel development (takes weeks/months).

- If not reversed within 6 hrs, limb cannot be recovered and if not amputated, P will die.


why can a P die of acute limb ischaemia

hyperkalaemia due to intracellular K+ release from necrotic tissue


what are the symptoms/signs of acute ischaemia

1. pain
2. paralysis
3. paraesthesia
4. pallor
5. perishing cold
6. pulselessness


what are the colour changes in an acutely ischaemic limb

1. white initially
2. fixed mottling (doesn't blanch when pressed) due to patchy cyanosis from lack of O2


what is intermittent claudication

pain in muscles of lower limb elicited by walking/exercise (calf muscles most frequently affected as commonly involves superficial femoral artery supplying calf) and rapidly relieved by rest


what are the important pulses to feel in the lower limb and where are these found

1. femoral pulse - mid-inguinal point
2. dorsalis pedis pulse - lateral to extensor hallucis longus
3. posterior tibial pulse - behind medial malleolus


what are the signs/symptoms of critical chronic limb ischaemia

1. rest pain: pain in the foot occuring when P goes to bed (no gravity, warmer so increased metabolic activity) and relieved by hanging foot out of bed
2. ulceration/gangrene