Acute arterial occlusion, aortic aneurysm, aortic dissection Flashcards
What are the essentials of diagnosis for acute arterial occlusion
- Sudden pain in limb + absent limb pulses
- Some degree of neurologic dysfunction with numbness, weakness, or complete paralysis
- Loss of light touch sensation requires revascularization within 3 hours to save limb
what is the presentation of acute arterial occlusion
what are the diagnostics used to diagnose acute arterial occlusion
most often clinical diagnosis, doppler used for pulse identification
what is the treatment for acute arterial occlusion
- IV heparin 1st
- then endovascular surgery for revascularization
- identify source (embolus = warfarin, PAD = statins, ASA, ACE)
what is the timing for revascularization in acute arterial occlusion
- should be accomplished w/in 3 hours
- irreversible tissue damage approaches 100% at 6 hours.
what are the essentials of diagnosis for abdominal aortic aneurysms
- Most AAAs are asymptomatic until rupture
- 80% measuring 5 cm are palpable; threshold for treatment is 5.5 cm
- Back or abdominal pain with aneurysmal tenderness may precede rupture
- Rupture is catastrophic: excruciating abdominal pain that radiates to the back; hypotension
when is abdominal aortic dilation considered an aneurysm
when dilation is >3cm
rare to rupture under 5cm
where do 90% of AAA develop
below the renal arteries
usually involves aortic bifurcation and common iliac arteries
what are risk factors for AAA
- male gender
- smoking
- family hx
- old age
what are the two major classification groups for AAA
- fusiform: circumferential expansion
- saccula: outpouching of a segment of the aorta
what is hte presentation of AAA
- could be asymptomatic
- mild-severe mid abdominal pain radiating to back
- exacerbation by palpation
what is the presentation of abdominal aortic aneurysm rupture
- severe pain
- palpable abdominal mass
- hypotension
what is the diagnostic study of choice for AAA
abdominal US
what are the screening reccomendations for AAA
1 time screening for men 65-75 who have smoked
If an aneurysm is found, what is the screening reccomendation after
- 3.0 - 3.4 cm : every 2 years
- 3.5 - 4.4 cm: every 12 months
- 4.5 - 5.4 cm: every 6 months and vascular surgery referral
what indicates elective vascular repair for AAA
- > 5.5 cm
- > 0.5cm growth within 6 months
- severe symtpoms
what is the leading cause of death in patients who undergo AAA repair
MI
what are the essentials of diagnosis of a thoracic aortic aneurysm
- Widened mediastinum on chest radiograph
- With rupture, sudden onset chest pain radiating to the back
what are possible causes of thoracic aneurysm
- atherosclerosis (MC)
- connective tissue disorders (marfans/EDS)
- bicuspid aortic valve disease
what is the presentation of a thoracic aortic aneurysm
- substernal back/neck pain
- Pressure on the trachea, esophagus, or superior vena cava can result in dyspnea, stridor, or brassy cough; dysphagia; and edema in the neck and arms as well as distended neck veins
- hoarsness (larygneal nerve pressure)
- aotic regurgitation murmur
how do you diagnose a thoracic aortic aneurysm
- CXR initially = widened mediastinum
- CT scan w contrast = modality of choice to show size and anatomy
what is the management for a thoracic aneurysm
- referall to CT surgeon regardless of size
- control risk factors
- control BP
what are the indications for surgical repair of a thoracic aortic aneurysm
> 5.5cm
what are the essentials of diagnosis of aortic dissection
- Sudden searing chest pain radiating to the back, abdomen, or neck in a hypertensive patient
- Widened mediastinum on CXR
- Pulse discrepancy in extremities
- Acute aortic regurg may develop
type A vs type B aortic dissection
- A = involves arch PROXIMAL to left subclavian artery
- B = DISTAL to left subclavian artery
what is the presntation of aortic dissection
- sudden severe chest pain radiating to back
- usually hypertensive
- aortic regurg murmur
what are the diagnostic modalities for aortic dissection
- EKG - LVH
- CXR widened mediastinum
- CT chest/abdomen w contrast = diagnostic modality of choice
what is the management for aortic dissection
- Lower systolic BP to 100-120 w labetalol or esmolol
- if its not lowering add on nicardipine or nitroprusside
- Morphine for pain
which aortic dissections require surgery
- all type A dissections
- type B dissections with sins of malperfusion
