APPLIED ANATOMY OF LOWER LIMB BLOOD
VESSELS
LEARNING OBJECTIVES
At the end of the lecture the student should be able to:
• Revise main arterial and venous supply of lower limb
• Know injuries or disease associated with vessels of lower limb
ARTERIAL SUPPLY
•
FEMORAL ARTERY
- Continuation of external iliac artery below the inguinal ligament
- Ends at adductor hiatus by becoming popliteal artery
- Gives of profunda femoris as its major branch
•
POPLITEAL ARTERY
- Gives genicular branches to supply knee joint
- Terminates in three branches
(a) Anterior tibial
(b) Posterior tibial
(c) Peroneal artery
ANGIOGRAM
VENOUS SUPPLY
•
LONG SAPHENOUS VEIN
– Continuation of dorsal venous arch
– Passes anterior to medial malleolus
– Passes through saphenous opening of fascia lata to drain into
femoral vein
– Tributaries:
• Superficial epigastric
• Superficial external pudendal
• Superficial circumflex iliac vein
• Communicating branches to small saphenous and
deep veins
•
SHORT SAPHENOUS VEIN
– Arises from lateral part of dorsal venous arch
– Passes posterior to lateral malleolus
– Asends up back of leg
– Drains into popliteal vein
–
LONG SAPHENOUS VEIN IS USED AS DONOR VEIN IN
CORONARY BYPASS GRAFTING.
•
•
PERFORATING VEINS
– Connects superficial great and small saphenous veins to deep veins
– Possess valves allowing flow of blood from superficial to deep veins only
VENOGRAM
DEEP VEIN THROMBOSIS
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•
Coagulation of blood in deep veins, resulting in
thrombus formation
Causes impairment of blood flow through deep veins
•
Virchow's triad:
Venous thrombosis occurs via three mechanisms:
1. Decreased flow rate of blood
2. Damage to blood vessel wall
3. Increased tendency of blood to clot
PREDISPOSING FACTORS:
• INCRESED THROMBOTIC TENDENCY
1.Deficiency of protein C, protein S, anti thrombin III.
2. Malignancy.
3. Dehydration
• STASIS
1. Bedridden patients
2. Cardiac failure
3. Prolong surgery
4. Prolong flight
• DAMAGE TO VESSEL WALL
1. Trauma
PRESENTATION:
1. Silent
2. Pain in calf muscle
3. Swelling of calf
4. Redness of skin and tenderness
5. Increased temperature of skin
EXAMINATION:
Unreliable for excluding diagnoses of DVT
INSPECTION:
– Swollen leg
– Redness of skin
PALPATION:
– Tenderness of calf muscles
– Warm calves
– Homan’s test
INVESTIGATION:
BLOOD TEST:
• D- dimers
IMAGING:
• Doppler ultrasound
• Duplex ultrasound
• Venography
TREATMENT:
• Complete bed rest
• Graduated compression stockings
• Anti coagulation (Injection Heparin or oral
warfarin)
COMPLICATIONS:
• Pulmonary embolism
• Post DVT limb
• Varicose veins
ARTERIO-VENOUS FISTULA
•
Abnormal connection between an artery and a vein.
CAUSES
• Congenital
• Surgically created for hemodialysis
• Acquired due to pathologic process, such as trauma or
erosion of an arterial aneurysm.
THROMBOEMBOLISM
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•
•
•
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Peripheral vascular disease
Usually affects lower leg
Arteriosclerosis
Stenosis of blood
Leading to thrombus and embolus formation
CAUSES:
• Diabetes
• Hypertension
• Smoking
• Increases cholesterol
• Age
• Decreased activity
PRESENTATION
• Intermittent claudication – pain on walking, relived
by rest
• Acute presentation
– Pale
– Pulseless
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–
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•
Painful
Paralysed
Paraesthetic
Perishing cold
INVESTIGATION
– Ankle brachial pressure index
– Angiography
– Doppler ultrasound
TREATMENT
• Conservative
– Lifestyle changes
– Stop smoking
– Healthy diet
•
Surgical
– Angioplasty
– Bypass graft
– Amputation extreme cases
TRAUMA
MECHANISM:
• Blunt injury
• Penetrating injury
• Blast injury
• Iatrogenic injury
DIAGNOSIS:
Clinical
• Pulseless, cold , pale limb
• Expanding haematoma
• Palpable thrill
• Audible bruit
• Active bleeding
IMAGING:
1. Duplex
2. Ultrasonography
3. Contrast enhance CT
4. Digital subtractions angiography
MANAGEMENT:
1. Haemorrhage control
2. Vascular repair