Arterial Disease and Aneurysms Flashcards by Srishti D

What are the possible sources of a cardiac embolus?

Atrial fibrillation
Infective endocarditis
Left ventricular aneurysm

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What is a possible source of an arterial to arterial embolus?

Thrombus in proximal larger vessel, most commonly ascending aorta

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What are some pro-coagulant states that can cause an arterial occlusion?

Pregnancy
Malignancy
Inherited disorders

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What are some low flow states that can cause an arterial occlusion?

Severe heart failure
Hypotension
Dehydration

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What are the possible causes of an arterial occlusion?

Athero-thrombus
Embolism
Pro-coagulant state
Low flow state
Thrombosed aneurysm
Dissection
Fibromuscular hyperplasia
Arteritis
Entrapment = compartment syndrome
Adventitial cysts

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What is fibromuscular hyperplasia?

Congenital anomaly of vessel wall, affecting small to moderate sized muscular arteries

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What are adventitial cysts?

Rare condition where cysts form in artery and narrow/occlude blood flow

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What is claudication?

Ischaemic pain in exercising muscles

Imbalance between workload of muscles and ability to maintain aerobic metabolism

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What metabolite builds up in claudication?

Lactic acid

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How is claudication clinically defined?

Calf +/- thigh +/- buttock pain on exertion
Onset and severity related to workload
Relieved with rest
Reproducible

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What is Leriche syndrome?

Claudication in common iliac artery causing claudication in
- Buttocks
- Thighs
- Calves
Can commonly get erectile dysfunction
Common in diabetes

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Where does ischaemic rest pain occur?

Most distal part of limb

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What does ischaemic rest pain imply?

Perfusion so poor that anaerobic metabolism present in skin and nerves of extremity

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What is a common presentation of ischaemic rest pain?

Foot perfusion aided by gravity
Patients wake with burning pain in extremity
Sit up and hang feet over edge of bed for relief
In worse case, spend all night sleeping in chair

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What are the patterns of lower limb occlusive disease?

Aorto-iliac
Femoro-popliteal
Tibial/crural

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What is the presentation of an aorto-iliac occlusive disease pattern?

Claudication
- Calf
- Thigh
- Buttock
Pulses
- Reduced femoral and below
?Bruit over aorta/iliac artery

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What is the presentation of a femoro-popliteal occlusive disease pattern?

Claudication
- Calf
Pulses
- Reasonable femoral
- Weak/absent popliteal and pedal pulses
Bruit along line of femoral/popliteal arteries

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What is the presentation of a tibial/crural occlusive disease pattern?

Claudication
- May be none
Pulses
- Popliteal reasonable
- Pedal pulses absent
Bruit over popliteal/upper tibial arteries

What are the considerations that need to be made when managing claudication?

Reasonable distance claudication benign - limb not in jeopardy
Any intervention or artery = controlled injury
Intervention may not work
Intervention may not be durable

When may an intervention for claudication be reasonable?

Claudication very significant handicap
Otherwise acceptablee risk
Proposed intervention has acceptable chance of working

What are the interventions available for claudication?

Angioplasty +/- stenting
Endarterectomy
Bypass

When is angioplasty +/- stenting best?

Short segments

Proximal arteries

When is endarterectomy best?

Short segments

When is bypass best?

Longer blocks

What are the characteristics of a nonviable limb?

Signs of - Tissue loss - Nerve damage - Sensory loss

What is the management of a nonviable limb?

Not much can do medically | Nave to surgically remove it

What are the characteristics of a viable limb?

No significant - Tissue loss - Nerve damage - Sensory loss

What is the management of a viable limb?

Define arterial anatomy with CT/MRI Urgent revascularisation Arterial thrombolysis as good as mechanical embolectomy

What are the indications for revascularisation?

Lifestyle limiting claudication with no improvement with exercise program Critical limb ischaemia symptoms Acute limb ischaemia

What is the management of claudication that is not lifestyle limiting?

``` Risk factor modification Annual followup to include monitoring for - Coronary artery disease - Cardiovascular disease - Ischaemic leg ```

What is the management of claudication that is lifestyle limiting?

Symptom relief | Physical therapy

What are the six Ps of an ischaemic limb?

``` Pain Pallor Paralysis Pulse deficit Parasthesia Poikilothermia ```

How does an ischaemic limb present?

Sudden onset of 6 Ps | Later pain in extremity lessens as nerve function ceases due to ischaemia

What is an aneurysm?

Consequence of atherosclerosis Focal arterial dilatation 1.25-1.5 greater diameter than adjacent normal artery Degenerative

What is the natural history of an aneurysm?

Continued expansion | Eventual rupture

What lines an aneurysm?

Thrombus

What is the commonest presentation of a burst abdominal aortic aneurysm?

``` Common in males >60 Abdominal pain Sometimes radiates to back Collapse Pulsatile mass in abdomen on palpation ```

What is the pathology of an aneurysm?

In media and adventitia - Destruction of elastin - Eventual failure of collagen Local inflammation

What is the primary prevention for aneurysms?

Cease cigarette smoking | Control hypertension

What is the secondary prevention for the rupture of aneurysms?

Screening and treatment of aneurysms >5-5.5 cm

What is the treatment approach for peripheral vascular disease?

All patients regardless of symptoms should have aggressive risk factor modification - Reduce blood pressure - Reduce LDLs - Smoking cessation - Anti platelet therapy - Aspirin - Clopidogrel

What imaging technique can detect aneurysms?

Doppler ultrasound

How much fluid should be given to someone with a ruptured abdominal aortic aneurysm and why?

No more than 3.5 L otherwise increase risk of mortality Because increase risk of cardiac output > more blood out of rupture, and colloids used have anticoagulant property If person comes in unconscious, don't bother with fluids