Aortic and Peripheral Arterial DIsease

Question 1

Define aneurysm

Answer 1

abnormal local dilatation of an artery, vein, or heart

Question 2

True aneurysm

Answer 2

outpouching of all three layers (intima, media, adventitia)

Question 3

False aneurysm

Answer 3

contained ruptures of the intima, media, and sometimes adventitia. Its contained by the tunica adventitia or perivascular thrombus.

Question 4

Aortic aneurysm more commonin who>

Answer 4

Old, white, males…most common in the abdomen (75%)

Question 5

Arteries undergo continuous remodelling throughout life mediated by what?

Answer 5

Matrix metalloproteinases

Question 6

C-reactive protein and IL-6 are markers of ?

Answer 6

Inflammation

Question 7

Whats going on in Marfans syndrome or Ehlers Danlos?

Answer 7

Fibrillin or collagen defects weaken the tunica media.

Question 8

Aneurysm symptoms

Answer 8

usually asymptomatic, may cause back pain if leaky

Question 9

Risk of rupture stats

Answer 9

<4cm….0.3%
4-4.9cm…1.5%
5-5.9cm…..6.5%

Question 10

Major factor in the rate of growth

Answer 10

Hypertension

Question 11

Some complications of an aortic aneurysm

Answer 11

mural thrombus formation, embolism of atheroma or thrombus, obstruction of aortic branches, aortoenteric fistulas
Rupture is obviously the most problematic.

Question 12

Aortic aneurysms are familial

Answer 12

true

Question 13

Catastrophic tear of the tunica intima allowing blod into the tunica media where it tunnels a second lumen

Answer 13

aortic dissection

Question 14

Type A aortic dissection

Answer 14

ascending aorta or arch

Question 15

Type B

Answer 15

descending alone

Question 16

Which is more common

Answer 16

Type A

Question 17

Aortic dissections associated with who?

Answer 17

late middle age black males

May also occur in younger patients with Marfan’s syndrome

Question 18

Dissections are associated with what state

Answer 18

Hypertensive stae

Question 19

Pathogenesis of a dissection

Answer 19

Intimal tear…can be caused by surgery

MVAs can cause an intimal tear at the ligamentum arteriosum

Question 20

Severe pain where for type A dissection

Answer 20

ANterior chest

Question 21

Pain where for TYpe B

Answer 21

Between the scapulae

Question 22

Peripheral arterial disease usually refers to what?

Answer 22

Chronic atherosclerotic occlusive disease of the large and medium arteries. Primarily seen in the legs. COmmon in the elderly

Question 23

Claudication

Answer 23

pain brought on by exercise and relieved by rest

Question 24

How do you evaluate for Peripheral arterial disease

Answer 24

measure blood pressure in the arm and lower leg, ratio less than 0.9 they’ve got it.

Question 25

treatment of peripheral arterial disease

Answer 25

walking (increases collateral vasculature)

Question 26

Acute arterial occlusion

Answer 26

uncommon, generally due to thromboembolism

Question 27

Beurger disease

Answer 27

Thrmboangiitis obliterans…chronic thrmbosing inflammatory disease of small and medium arteries and veins of arms and legs

Question 28

Beurger disease associated with what?

Answer 28

smoking

Question 29

Acute and chronic phase. Describe them

Answer 29

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.

Question 30

Signs and symptoms of bruegers disease

Answer 30

instep claudication, cold feet,

Question 31

Pathogenesis of an aneurysm

Answer 31

Usually an interplay between atherosclerosis and genetic predisposition to degeneration of the tunica media