Aortic and Peripheral Arterial DIsease Flashcards
Define aneurysm
abnormal local dilatation of an artery, vein, or heart
True aneurysm
outpouching of all three layers (intima, media, adventitia)
False aneurysm
contained ruptures of the intima, media, and sometimes adventitia. Its contained by the tunica adventitia or perivascular thrombus.
Aortic aneurysm more commonin who>
Old, white, males…most common in the abdomen (75%)
Arteries undergo continuous remodelling throughout life mediated by what?
Matrix metalloproteinases
C-reactive protein and IL-6 are markers of ?
Inflammation
Whats going on in Marfans syndrome or Ehlers Danlos?
Fibrillin or collagen defects weaken the tunica media.
Aneurysm symptoms
usually asymptomatic, may cause back pain if leaky
Risk of rupture stats
<4cm….0.3%
4-4.9cm…1.5%
5-5.9cm…..6.5%
Major factor in the rate of growth
Hypertension
Some complications of an aortic aneurysm
mural thrombus formation, embolism of atheroma or thrombus, obstruction of aortic branches, aortoenteric fistulas
Rupture is obviously the most problematic.
Aortic aneurysms are familial
true
Catastrophic tear of the tunica intima allowing blod into the tunica media where it tunnels a second lumen
aortic dissection
Type A aortic dissection
ascending aorta or arch
Type B
descending alone
Which is more common
Type A
Aortic dissections associated with who?
late middle age black males
May also occur in younger patients with Marfan’s syndrome
Dissections are associated with what state
Hypertensive stae
Pathogenesis of a dissection
Intimal tear…can be caused by surgery
MVAs can cause an intimal tear at the ligamentum arteriosum
Severe pain where for type A dissection
ANterior chest
Pain where for TYpe B
Between the scapulae
Peripheral arterial disease usually refers to what?
Chronic atherosclerotic occlusive disease of the large and medium arteries. Primarily seen in the legs. COmmon in the elderly
Claudication
pain brought on by exercise and relieved by rest
How do you evaluate for Peripheral arterial disease
measure blood pressure in the arm and lower leg, ratio less than 0.9 they’ve got it.
treatment of peripheral arterial disease
walking (increases collateral vasculature)
Acute arterial occlusion
uncommon, generally due to thromboembolism
Beurger disease
Thrmboangiitis obliterans…chronic thrmbosing inflammatory disease of small and medium arteries and veins of arms and legs
Beurger disease associated with what?
smoking
Acute and chronic phase. Describe them
Acute involves transmural acute inflammation with granulomas and giant cells, but without necrosis. Thromboses have microabcesses in the thrombus.
Chronic involves nonspecific organization and recenalization of the thrombus with neovascularization and fibrosis.
Signs and symptoms of bruegers disease
instep claudication, cold feet,
Pathogenesis of an aneurysm
Usually an interplay between atherosclerosis and genetic predisposition to degeneration of the tunica media
