Aneurysms and Vascular Disease Flashcards
What is PAD?
Thickening of the arteriole wall, causing narrowing/stenosis to the artery
What does PAD lead to?
Decreased perfusion of blood to the extremities
What is the leading cause of PAD?
Atherosclerosis
What are risk factors for PAD?
Tobacco use DM Hyperlipidemia Uncontrolled HTN Obesity Sedentary lifestyle Stress
How does tobacco contribute to PAD?
Nicotine is a potent vasoconstrictor
Impairs transport and cellular use of O2
Increases blood viscosities
What is a clinical manifestation of PAD?
Intermittent claudication (during exercise) - Cramping from decreased blood flow and muscles not receiving enough O2 -> anaerobic metabolism
What are some complications from PAD?
Amputation
Ulcers from decreased circulation
How is PAD diagnosed?
Doppler studies
Ankle-brachial indexes
Angiography
MRI testing
How is PAD treated?
Smoking cessation Exercise Maintaining an ideal body weight Reviewing diet Addressing BP issues Drug therapy - oral antiplatelet (Aspirin or Plavix) Surgery (bypass grafting)
What is venous thrombus disease?
Formation of clots in the venous system
What are the classifications of venous thrombus disease?
Superficial vein thrombosis
DVT
Venous thromboembolim
What is superficial vein thrombosis?
Formation of a thrombus in the superficial vein
Usually greater or lesser saphenous veins
What is DVT?
Thrombus in a deep vein
Usually in iliac or femoral vein
What is Virchow’s triad?
Three main contributing factors to the development of venous thromboembolism
Venous stasis
Damage of endothelium
Hypercoagulability of the blood
How does a patient with a venous clot present?
Lower extremity VTE may or may not have edema
May complain of tenderness on palpation
May have dilated superficial veins
May complain of a sense of fullness
Skin may be warm, reddened, or may have a temp >104
What diagnostic testing can be used for venous disease?
Duplex study Ultrasound Blood studies PTT, INR, bleeding time, HgB, HCt, platelet count CT scan venography MRI
What drugs can be used for VTE?
Warfarin/Coumadin to avoid further clotting
Heparin to prevent further clotting
Low molecular weight heparin (Lovonox)
Acava and Prodaxa
PAD vs venous disease pulses:
PAD pulses: weak
venous disease pulses: bounding
PAD vs venous disease cap refill:
PAD cap refill: >3 seconds
venous disease cap refill: <3 second
PAD vs venous disease edema:
PAD: usually no edema
venous disease edema: common in lower legs
PAD vs venous disease hair:
PAD: can be loss of hair
venous disease: can be loss of hair
PAD vs venous disease pain:
PAD: intermittent claudication
venous disease: may complain of dull, achy pain, or heaviness
PAD vs venous disease nails:
PAD: thickened, brittle nails
venous disease: normal or slightly thickened nails
PAD vs venous disease skin:
PAD: cool skin that will get cooler toward distal extremity
venous disease: thick, hardened, indurated (raised) skin
PAD vs venous disease pruritis:
PAD: no pruritis
venous disease: complains of pruritis
PAD vs venous disease skin color:
PAD: feet can be red in color if in dependent position; elevated feet will appear pale
venous disease: feet can be red to brown/bronze from pooling of blood
PAD vs venous disease optimal positioning:
PAD: dependent extremity to aid flow of blood from heart to extremity
venous disease: feet elevated above heart to assist gravity in moving blood towards heart
What is an aneurysm?
A permanent, localized dilation/outpouching of a blood vessel wall
Which gender are aneurysms more common in?
Men
How are aneurysms classified?
True
False
What is a true aneurysm and what are the 2 subclassifications?
The wall of the artery forms an aneurysm with at least one vessel layer still in tact
Fusiform aneurysm: circumferential and uniform in shape - circle entire aorta
Saccular aneurysm: pouch-like, with narrow neck connecting bulge of one side of the arterial wall
What is a false aneurysm?
Disruption of the arterial wall layer with bleeding contained by surrounding anatomic structures
What type of aneurysm is the most common site for dissection?
Thoracic aneurysms
What is a dissection?
Different layers of the artery separating or tearing from each other
What are signs of aneurysms?
Pain - can radiate to scapular area
Dypsnea, cough, hoarseness, dysphagia
Why can people with abdominal aortic aneurysms “feel their heart beating”?
Due to an outpouching of the wall
What is a hallmark complaint of an AAA?
Lower back pain
What issues can an AAA lead to?
Dissection of the aorta
Rupture
What is an aortic rupture?
Hole is created within the aorta - blood is released into the cavity and pt is at high risk for exsanguination
How can you diagnose an AAA?
Ultrasound
Xray
MRI
Angiography
How do you decide between a medical and surgical treatment for an AAA?
Size
Small aneurysms will be followed with frequently ultrasounds
Large or growing aneurysms will receive grafting
