Vascular_2

Question 1

Name for a localised round atrophic regions surrounded by dilated capillaries, typically caused by deep venous insufficiency

Answer 1

Atrophie Blanche

Question 2

Causes (2) of deep venous insufficiency

Answer 2

• DVT
• valvular insufficiency

Question 3

Characteristics (3) of the failure of venous system

Answer 3

• venous hypertension
• obstruction
• valvular reflex

Question 4

What’s the difference between Deep Venous Insufficiency and Varicose Veins?

Answer 4

Deep venous insufficiency -> affects deep venous system

Varicose veins -> affects superficial veins

Question 5

Symptoms of Deep Venous Insufficiency

Answer 5

• chronically swollen limbs
• pruritis
• pain/ache
• bruises
• tightness on walking -> resolves with leg elevation

Question 6

Signs of Deep Venous Insufficiency

Answer 6

• pedal oedema
• varicose eczema -> dry and scaly skin
• thrombophlebitis
• skin staining
• lipodermatosclerosis
• atrophie blanche
• possibly venous ulcers (usually around median malleolus)

Question 7

Symptoms of Post Thrombotic Syndrome

Answer 7

Post Thrombotic Syndrome (post-DVT)

• heaviness
• cramps
• pain
• pruritis
• paraesthesia
• pretibial oedema
• skin hyperpigmentation, induration
• venous ectasia
• redness and ulceration

Question 8

What scale is used to monitor degree of Post-Thrombotic Syndrome?

Answer 8

Villalta Scale

Question 9

Management of Deep Venous Insufficiency

Answer 9

• 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)

Question 10

What 3 factors influence blood flow through the vessel?

Answer 10

• viscosity
• radius
• length

Question 11

How do the length and viscosity influence the blood flow through the vessel if it’s x2?

Answer 11

blood flow will be / (decreased) by 2

Question 12

If the radius of the vessel is halved (50% less) how would it influence the blood flow through that vessel?

Answer 12

Blood flow will be divided by 16 (16 less)

Question 13

Why can we hear the bruit?

Answer 13

There will be narrowing -> turbulent blood flow at the point of atherosclerosis

Question 14

What happens when there is 50% of occlusion of the artery lumen?

What happens when there is 70%?

Answer 14

Changes start at 50% -> reduction of radious of the vessel

70% -> critical stenosis

Question 15

What’s DSA?

Answer 15

• 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

Question 17

How to calculate ABPI?

Answer 17

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)

Question 18

What if ABPI is above 1.0 e.g. 1.2?

Answer 18

That’s a false high

• happens in e.g. DM (as the vessels are calcified so higher pressure needed to detect it)

Question 19

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

Answer 19

• >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

Question 20

What ABPI ranges TED stocking is used for?

Answer 20

• 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.

Question 21

What’s post-thrombotic syndrome?

Answer 21

• 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

Question 22

What’s responsible for colour changes around venous ulcer?

Answer 22

deposits of haemosiderin (a breakdown product of RBC) in the skin

Question 23

What causes an inverted champagne bottle appearance in the venous ulcers?

Answer 23

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)

Question 24

Why arterial/ neuropathic ulcers are known to have ‘punched out’ appearance?

Answer 24

The blood flow to the wound will be decreased (as arterial disease) -> healing is impaired

Question 25

What’s VAC?

Answer 25

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

Question 26

What’s the appropriate angle we hold a Doppler probe at?

Answer 26

60 degrees

*hold it like a pen

Question 28

What causes tapering/reducement of the legs above the ankles (“inverted champagne bottle”)

Answer 28

lipodermatosclerosis

Question 29

What happens in varicose veins? (pathophysiology)

Answer 29

Valvular incompetence -> blood from deep venous system -> into superficial venous system -> venous hypertension and dilation of superficial veins

Question 30

Gold standard investigation for suspected varicose vein

Answer 30

Duplex ultrasound

Question 31

Characteristic location for venus ulcer

Answer 31

Median malleolus