Aortic and Peripheral Arterial Diseases (Nichols) Flashcards
an abnormal localized dilation of an artery, vein, or heart itself
aneurism
What layers of a vessel are involved?
all 3 are BALLOONED OUT
how is a false aneurysm different than a true aneurysm?
pseudoaneurysm is a RUPTURE of 1, 2, or 3 layers
if only or 2 layers, the adventitia is holding it together
if adventita is involved, then a perivascular thrombus is holding it together
What are the risk factors for developing an aortic aneurysm?
elderly family Hx smoking** Male HTN** Hyperlipidemia
Where in the bidy are aortic aneurysms most common?
abdomen (75%)
What is a universal finding with aneurysms?
thrombus formation (due to abn blood flow)
At the periphery of the aneurysm there is ____ flow and at the surface of an aneurysm there is _____ flow
stasis
turbulent
T or F: emboli can occur from thrombi that form at the site of an aneurysm.
T
What is the pathogenesis of aneurysms?
combo of
- artherloscleroerosis
- genetically determined degeneration of T media
* 2 hit disease
WHat is the microscopic manifestation of aneurysms?
“cystic media degeneration”
fragmentation an loss of elastic fibers –>
cystic areas of myxoid matrix
Aneurysms are a disease of the _____
artherlosclerosis is a disease of the ____
What is the link between these
T media (loss of elastic tissue in muscle) T intima
Artherlosclerosis causes inflammation and it is thought that the inflammation in the T media spills over into the T media and causes destruction
person says “I dont feel good” then drops over dead
What killed them
AAA
marfan syndrome and Erlos Danlos
aortic aneurysm without artherlosclerosis
What is the 4 etiologies of aneuyrsms?
- spillover inflammation from artherlosclerosis brings MMPs which degrades collagen in T media
- Genetic: defects in fibrillin or collagen (marfan’s syndrome)
- infection
- vasculitis (giant cell arteritis)
giant cell arteritis
vasculitis as an etiology of AAA
What is the major determinant of whether the aneurysm will rupture?
the diameter of the bulge
**greater the diameter = greater risk of rupture
What are the 5 complications of aneurisms?
- rupture
- thrombus formation
- embolism of artheroma or thrombus
- obstruction of aortic branches
- aortoenteric fistula
continuous pounding of the wall of the aorta onto bowel –> damage to wall of intestines –> channel between aorta and bowel made –> blood goes into bowel
aortoenteric fistula
difference between a aortic dissection and an aortic aneurysm
dissection is a hole causing a bulge and aneurism is a bulge
dissection is a surgical emergency and an aneurysm is not
Symptoms of aortic aneurysm
Signs
Dx
Tx
usually none but may cause back pain if leaking, sometimes there is a pulsatile mass that is palpable in thin patients
none
imaging (ultrasound)
stenting or open repair
catastrophic tear of the tunica intima letting luminal blood enter under high pressure into the T media where it tunnels a 2nd lumen
aortic dissection
Aortic dissection is always _____
a medical emergency
Type A aortic dissection involves the _____
B involves ___
Which is more common? serious?
ascending aorta
descending aorta
A and A
Aortic dissection is most common in
black (middle aged)
What is the pathogenesis of aortic dissection?
intimal tear: cannot tell
medial tear: assc with cystic medial degeneration (degenerative disease)
false lumen
aortic dissection
double barrel aortia
aortic dissection
What are the symptoms of aortic dissection?
A: sudden severe sharp “tearing” chest pain
B: sudden severe pain between scapulae
sudden and severe arm pain/weakness normal EKG
subclavian dissection
sudden altered mental status
carotid dissection
How is the pain of an MI different than the pain of an aortic dissection
MI: dull
AD: sharp and tearing
T or F: As the pain assc with an aortic dissection moves, the dissection progresses
true
What are complications of aortic dissections? (2)
occlusion of aortic branches
rupture commonly into pericardium and less often into left pleural cavity
How is the Dx of an aortic dissection made?
Tranesophageal ECG or CT or MRI
What is the Tx for aortic dissection?
reduce BP to low normal
surgery (esp type A)
Will the aorta ever become obstrcted by the false lumen? Why?
No bc the pressure in the false lumen is always lower than the true lumen
chronic artherosclerotic occlusive disease of large and medium arteries, primarily in the legs
peripheral arterial disease
limb pain brought on by exercise, relieved by rest
intermittent claudication
peripheral arterial disease
limb pain at rest and ulcers indicates
severe peripheral arterial disease
when the intermittent claudication occurs in the calf muscles what arteries are diseased?
femoral or popliteal
peripheral arterial disease
signs of peripheral arterial disease
diminished or lost dital pulses bruits pallor or cyanosis skin atrophy muscle atrophy ulceration gangrene necrosis
What is the Tx for peripheral arterial disease?
EXERCISE (esp walking) bc it develops collateral circulation)
uncommon condition due to thromboemboli from heart (80% cases)
acute arterial occlusion
acute arterial occlusion is a _______
medical emergency
What are the 5 signs and symptoms of acute arterial occlusion?
5 Ps pain pallor paralysis parasthesia pulselesness in the legs (70%) or arms (8%)
Where can acute arterial occlusion occur?
legs > arms > brain > intestines, kidneys, spleen
What is the Tx for acute arterial occlusion?
heparin
intra-arterial thrombolytic therapy
pull out with catheter
surgery
chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs
buerger disease
100% of buerger dosease cases are assc with ______
smoking
another name for buerger disease
thromboangiitis obliterans
Epidemiology of buergers
SE asian in 20s and no older than 40s
what is the microscopic pathology of acute buerger’s disease
chronic?
segmental tranmural inflammation without necrosis = vasculitis
+thromboses
+granulomas
+giant cells
Chronic: organization of thrombus with neovascularization and fibrosis
What is the big difference between buerger’s disease and acute arterial occlusion?
buergers can involve the hands and fingers
What are the symptoms of beurger’s?
Signs?
Tx:
instep claudication
cold feet
raynaud’s phenomenon
gangrene, nodular thrombophlebitis, ulcerations
stop smoking an amputation
WHat is ectasia?
generalized dilation of a blood vessel that is usually assc with aging
Where can aneurysms form?
artery, vein, or heart
Elevated blood levels of ____ and ____ are assc with the formation of aneurysms
C-reactive protein and IL-6
_____ accelerates the rate of growth of an aneurysm and _____ is a major factor in the rate of growth
HTN and BP
in motor vehicle accidents, an intimal tear of the _____ or rupture of the ____ can lead to the development of an aneurysm
ligamentum arteriosum
vasa vasorum
pain brought on by exercise and relieved by rest
intermittent claudication (peripheral arterial disease)
65% of the thrombi in acute arterial occlusion come from …
mural thrombi that developed after an MI
acute arterial occlusion is occasionaly due to thrombus formation in situ… what 3 conditions most commonly cause this in situ thrombus formation
artherosclerotic plaque ulcer or rupture
HIT (heparin induced thrombocytopenia)
anti-phospholipid Ab syndrome
microscopically, thromboses with “microabscesses” in thrombus
buerger disease
Angiogram shows stenoses (more distally) with corkscrew collaterals
Buerger syndrome
What is raynaud’s syndrome?
vasospasm of finger arteries with cold exposure –> white –> blue –> red
