Aortic and Peripheral Vascular Disease

Question 1

What is arteriosclerosis? 3 Types

Answer 1

Arteriosclerosis = hardening/thickening of artery walls

• 1- Atherosclerosis (intimal fibro-fatty plaques)
• 2- Monckeberg Medial Sclerosis (calcification/ossification of muscular media)
  
  • Often found incidentally in older pts; benign b/c does not impinge on vessel wall
• 3- Arteriolar Sclerosis (involves arterioles)
  
  • Hyperplastic - intimal thickening
  • Hyaline - acellular thickening
  • THINK hypertension + kidney disease

Question 2

What are the 9 risk factors for atherosclerosis?

Answer 2

• Non-modifiable - age/gender/genetics
• Major Modifiable - DM/smoking/HTN/hyperlipidemia
• Minor Modifiable - obesity/lifestyle

Question 3

5 Most Common Sites of Atherosclerosis

Answer 3

• Lower ab aorta
• Coronary arteries
• Popliteal arteries
• Internal carotid
• Circle of Willis

Question 4

What is an aneurysm? 5 Types

Answer 4

Aneurysm - weakening of vessel wall (can then lead to dilatation or rupture)

• 1- Saccular - Balloons of 1 side of vessel; involves all 3 layers on that side
• 2- Fusiform - Whole circumference of vessel balloons out
• 3- Dissecting - blood trapped in weak media
• 4- Syphilitic - from tertiary syphilis
  
  • Treponema invades vasa vasorum –> calcifies/destroys elastic lamina so inside of aorta looks like tree bark
  • Leads to dilatation of aorta and aortic insufficiency
• 5- Mycotic - due to infection of vessel (usually bac or fungal)

Question 5

Which aneurysms are due to atherosclerosis?

Answer 5

Fusiform like AAA

And dissecting can be due to HTN/atherosclerosis can weaken media

Saccular (berry), Syphilitic, Mycotic are NOT DUE TO ATHEROSCLEROSIS

Question 6

AAA

Answer 6

• Type of fusiform aneurysm
• DUE TO ATHEROSCLEROSIS -plaques damage/weaken media
• Usually below renal arteries
• Clinical - pulsatile ab mass (feel > 5 cm on physical exam); if ruptures –> sudden death
• Tx - aortic graft (new pipe)

Question 7

Berry Aneurysm

Answer 7

• Type of saccular aneurysm
• NOT DUE TO ATHEROSCLEROSIS; congenital weakening of vessel wall
• Usually at Circle of Willis branch pts
• If ruptures –> subarachnoid hemorrhage or intraparenchymal hematoma; sudden onset of worst headache of life and sudden LOC

Question 8

Aortic Dissection

Answer 8

• 2 types - HTN/atherosclerosis OR Marfan Syndrome
• Pathogenesis - cystic medial degeneration of media (softens media/less elastic/weaker) then blood gets thru intima into media and trapped b/c media is weak
• Clinical - sudden onset chest pain –> back; wide mediastinum on X-ray
• Type A - starts in ascending aorta
• Type B - starts in descending aorta

Question 9

Thrombophlebitis vs. Phlebothrombosis

Answer 9

• Thrombophlebitis - DVT w/ inflammation

* Phlebothrombosis - DVT w/o inflammation

Question 10

Superior or Inferior Vena Cava Syndrome

Answer 10

• Obstruction of vena cava

* Often due to neoplasm (ex- lung cancer, liver cancer)