Aortic and Peripheral Vascular Disease

Question 1

Risk factors for Aortic dissection

Answer 1

Hypertension
Collagen Disorders
Pregnancy
Congenital Heart Defects

Question 2

Pathophysiology of Aortic Dissection

Answer 2

Medial degeneration (loss of smooth muscle/elastic fibers)
Repeated Flexion of the Aorta
Hydrodynamic Stress on the Intima

Question 3

Which types of Aortic Dissection should be sent straight to surgery

Answer 3

DeBakey Type I and II – In the aortic arch

Only do type III if it is compressing a major artery

Question 4

How does an aortic dissection patient present

Answer 4

Pain -- Tearing, Ripping
Migrating Pain
Vasovagal Symptoms
Syncope
Neurological Defecit

Question 5

Physical Exam findings in an aortic dissection

Answer 5

Apprehensive, Sense of Impending Doom
Tachycardia
Cool, Clammy Skin
BP Disconnect
Murmur like aortic regurg
Signs of tamponade

Question 6

Common diognostic tests ordered for aortic dissection

Answer 6

Labs (CBC, blood typing, etc.)
ECG
Imaging

Question 7

Imaging modalities used in an aortic dissection patient?

Answer 7

Aortography
CT
Echo/TEE
CXR

Question 8

How do you treat Type B dissections

Answer 8

BP control – Beta Blockers

Surgery if increasing pain, HTN, Major Branch Occlusion

Question 9

Risk factors for AAA

Answer 9

Age over 65
Peripheral Artery Disease
Familial Hypercholesterolemia
Other atrial aneyursms

Question 10

AAA usually ruptures when bigger than what size

Answer 10

5cm

Question 11

Presentation of an unruptured AAA

Answer 11

Abdominal Pain, Back, or Flank Pain
Gradual Onset
Vague/Dull Colicky Pain

Question 12

Presentation of ruptured AAA

Answer 12

Pain
Hypotension
Pulsatile abdominal mass

Question 13

How to manage AAA

Answer 13

Serial ultrasounds until above 4.0 cm or symptomatic

With symptoms or over 4cm, do surgical repair (endovascular or open)

Question 14

Atherosclerosis risk factors

Answer 14

Cigarette smoking
Diabetes
Hypercholesterolemia
HTN

Question 15

Presentations of PAD

Answer 15

Thromboembolic

Symptoms of Claudication

Question 16

Describe Arterial Insufficiency (Effects of movement, elevation, pulses, compression, overall effect)

Answer 16

Symptoms worse with ambulation
Elevating it makes it worse
Weak/Absent Pulses
Compression worsens it
Lack of oxygenated blood to tissues

Question 17

Describe Venous Insufficiency (Effects of movement, elevation, pulses, compression, overall effect)

Answer 17

Symptoms improve with ambulation
Elevation helps
Normal pulses
Compression helps
Excess of deoxygenated blood pooling in tissues

Question 18

How do you diagnose arterial insufficiency?

Answer 18

Segmental Arterial Pressure Study
Ankle Brachial Index
Angiogram

Question 19

What ABI value is considered significant disease

Answer 19

Below 0.7

Question 20

When would you treat PAD with surgery?

Answer 20

Acute thrombosis
Intractable rest pain from ischemia
Gangrenous limbs

Question 21

Medical therapy for less severe PAD

Answer 21

Anti-platelet therapy
Compression therapy
Follow symptoms
Encourage smking cessation

Question 22

Why is there more PVD in superficial veins?

Answer 22

Vessels are more fragile, less developed

They lack structural support from superficial tissue

Question 23

Physical findings associated with PVD

Answer 23

Venulectasia/Telangiectasia
Tributary and Small Vessel Disease
Hyperpigmentation
Eczematoid Dermatitis
Atrophie Blanche
Corona Phlebectatica
Stasis Dermatitis
Lipodermatosclerosis
Superficial thrombophlebitis
Stasis Ulceration

Question 24

What is hyperpigmentation in PVD caused by

Answer 24

Hemosiderin deposits between the vessel wall and the skin

Question 25

What is eczematoid dermatitis

Answer 25

Inflammation adjacent to a bulbous tributaty

Question 26

What is atrophie blanche

Answer 26

Inflammation/Scarring leading to plaques of the skin with no pigment

Question 27

What is corona phlebectatica?

Answer 27

Red Flare | Precursor to stasis ulceration

Question 28

What is stasis dermatitis

Answer 28

Heavy inflammatory changes in the gaiter area bilaterally in a patient with bilateral saphenous reflux

Question 29

What is lipodermatosclerosis

Answer 29

Sclerosis Panniculitis Painful inflammatory lesions that are firm and contracted Inside of leg caved in, Inflamm calcified

Question 30

What is superficial thrombophlebitis

Answer 30

Firm palpable cords over superficial varicies Overlying Inflammation Seasonal patterns common

Question 31

Primary causes of varicose veins?

Answer 31

Heredity, Hormonal, Pregnancy effects, Gravity

Question 32

Secondary causes of varicose veins?

Answer 32

Obesity, Trauma, Gravity, Occupations with prolonged sitting/standing

Question 33

Why are varicose veins a disease

Answer 33

They lead to complications from chronic venous hypertension

Question 34

Complications of Vein Disease

Answer 34

``` Superficial Phlebitis Deep venous thrombosis Venous Stasis Demarcation/Ulceration Bleeding Chronic Pain ```

Question 35

How do you evaluate veins?

Answer 35

Hand held doppler | Whole leg duplex mapping

Question 36

Virchow's Triad?

Answer 36

Injury Stasis Inherited/Acquired Changes

Question 37

When to consider thrombophilia

Answer 37

``` Young patient with VTE Recurrent idiopathic or unusual site thrombosis Family History of VTE Multiple Miscarriages Heparin Resistance Warfarin Induced Skin Necrosis ```

Question 38

Hereditary causes of thrombophilia

Answer 38

``` Antithrombin Def Protein C&S Def APC/Factor V Leiden Mutation Prothrombin Mutation Hyperhomocysteinemia ```

Question 39

Acquired causes of thrombophilia

Answer 39

Anti-PLA Syndrome HIT Malignancy