Week 226 Peripheral Vascular Disease

Question 1

Week 226

What are the 6 P’s that indicate Peripheral vascular disease (severe)?

Answer 1

• Pain
• Paraesthesia
• Paralysis
• Pallor
• Perishingly Cold Limb
• Pulselessness
• (Punched out - AKA Arterial - Ulcers)

Question 2

Week 226

Pain from Claudication in say, the leg, is worsened if you do what to the limb?

Answer 2

Raise it. OUch!

Question 3

Week 226

What is the name given to this Clinical sign? What does it indicate?

Answer 3

This is levido reticulares (lace like purplish discolouration)

This is a sign of atherosclerotic stenosis and occlusion.

Question 4

Week 226

Describe the key characteristics of Arterial ulcers.

Answer 4

• Over bony prominences
• Smaller than venous ulcers
• Sharply demarcated border
• Punched out
• Necrotic centre
• Blanched appearance of surrounding skin

Question 5

Week 226

What are the key characteristics of venous ulcers?

Answer 5

• Over soft tissue or bone
• Most common in gaiter region
• Larger than arterial
• Relatively painless
• Ireegular, poorly defined border
• Superficial appearance
• Granulating centre
• Increased exudate
• Hyperpigmented surrounding skin

Question 6

Week 226

What is Buerger’s test? What is it used for?

Answer 6

With pt lying on back, perform a straight leg raise
(to a maximum of 45 ̊), and
note the angle at which leg becomes pale
o
After 2 mins, swing legs over edge of bed. A diseased leg will turn a ‘sunset red’ due to
reactive hyperaemia.

This is a sign of atherosclerotic occlusion and stenosis.

Question 7

Week 226

What is the ABPI? Why is it useful in peripheral vascular disease diagnosis?

Answer 7

• Ankle Brachial Pressure Index
• Ratio of: Highest of Dorsalis pedis/Post. Tibial BP: Highest of Brachial BP
• Calculated for EACH leg.
• Health = 0.9-1.1
• In arterial ulceration it’s less than 0.5

Question 8

Week 226

In a healthy person, what do doppler pulse studies of the leg show?

Answer 8

• A triphasic waveform.
• FWD flow in systole, rebound and reverse in early diastole, and forward in late diastole

Question 9

Week 226

In a patient with peripheral vascular disease, what do you expect to see on a Doppler Pulse study?

Answer 9

Monophasic waveform.

Question 10

Week 226

What are the treatment options for peripheral vascular disease?

Answer 10

• Surgical restorartion (balloon, stenting, bypass graft)
• Keep dry and clean
• Analgesia
• Antiplatelets and statins

Question 11

Week 226

What is the primary cause of venous hypertension?

Answer 11

Valvular incompetence

Question 12

Week 226

What causes venous Eczema?

Answer 12

Inflamation and fibrosis of skin due to chronic venous oedemam which causes haemosiderin deposition.

Question 13

Week 226

What is Lipodermatosclerosis?

Answer 13

This is a symptom of venous hypertension. Brown, smooth, tightened skin. Caused by scarring of skin and underlying fat. Results in inverse champagne bottle shape.

Question 14

Week 226

When is the venous refill test used? What is it?

Answer 14

Pt asked to use calf muscle pump to empty superfic veins. Pt then stood still to allow refill.

Venous refill time should be >120secs in healthy pts

Symptomatic pts will have VRT <40s.

Ulceration likely in pts with VRT <10

Question 15

Week 226

What is the Trendelenburg test?

Answer 15

Used to determine which incompetent valves are responsible for varicose veins. Elevate leg and compress SFJ. Slow filling suggests problem at SFJ, fast filling suggests incompetent perforators.

Question 16

Week 226

Are compression stockings suitable with an ABPI of less than 0.5?

Answer 16

No! This suggests arterial insufficiency. Nooooooooo

Question 17

Week 226

How wide are capillaries?

Answer 17

4-8 micrometres

Question 18

Week 226

How wide are post-capillary venules?

Answer 18

15 micrometres. Permeability is increased in inflammation.

Question 19

Week 226

How wide are AV anastomoses?

Answer 19

100 micrometres

Question 20

Week 226

What are continuous capillaries, and where do they occur?

Answer 20

• Occur in skin, muscle, lungs, connective tissue, CNS
• Contain small pores (not existent in CNS = blood brain barrier)

Question 21

Week 226

What are fenestrated capillaries, and where are they found?

Answer 21

• These occur in areas of increased fluid filtration out of the capillaries. I.E kidneys, choroid plexus, ciliary bodies, GI mucosa, endo/exocrine glands
• They contain small pores = 15NM wide

Question 22

Week 226

Sinusoids are a type of capillary. Where are they found?

Answer 22

These occur in areas of increased cellular exchange i.e. spleen, liver, bone marrow. They form endothelium with large gaps (100nm wide), forming a discontinuous basement membrane.

Question 23

Week 226

What is photoplethysmography?

Answer 23

BP of the toe.

Question 24

Week 226

What is peak systolic velocity ratio?

Answer 24

This = PSV in stenosis/PSV in vessels next to stenosis

PSV 2 = 50% stenosis

PSV 3 = 70% Stenosis