ARTERIAL DISORDERS Flashcards
⚡⚡ MOST COMMON type of ANEURYSM (morphology)
Fusiform ANEURYSM
🌸 TYPES of ANEURYSM
🧠⚡MAD SCAB ⚡
- Mycotic
- Atherosclerotic
- Dissecting
- Syphilictic
- Capillary Micro-aneurysm
- AV-Fistula
- Berry ANEURYSM
Shapes of ANEURYSM
⚡⚡ MOST COMMON VESSEL INVOLVED IN ANEURYSM
⚡⚡ MOST COMMON EXTRA-CRANIAL VESSEL INVOLVED IN ANEURYSM
⚡⚡ MOST COMMON PERIPHERAL VESSEL INVOLVED IN ANEURYSM
⚡⚡ MOST COMMON VISCERAL VESSEL INVOLVED IN ANEURYSM
⚡⚡ MOST COMMON VESSEL INVOLVED IN MYCOTIC ANEURYSM
⚡⚡ MOST COMMON VESSEL INVOLVED IN ANEURYSM
🎯 CIRCLE OF WILLIS
⚡⚡ MOST COMMON EXTRA-CRANIAL VESSEL INVOLVED IN ANEURYSM
🎯 INFRA-RENAL ABDOMINAL AORTA
⚡⚡ MOST COMMON PERIPHERAL VESSEL INVOLVED IN ANEURYSM
🎯 POPLITEAL ARTERY
⚡⚡ MOST COMMON VISCERAL VESSEL INVOLVED IN ANEURYSM
🎯 SPLENIC ARTERY
⚡⚡ MOST COMMON VESSEL INVOLVED IN MYCOTIC ANEURYSM
🎯 AORTA
⚡⚡ MOST COMMON CAUSE OF MYCOTIC ANEURYSM
Staphylococcus aureus
⚡⚡ MOST COMMON SITE OF PSEUDO-ANEURYSM
⭐ CAUSE
Femoral ARTERY
⭐ CAUSE: Cannulation (OR) Trauma
⚡⚡ MOST IMPORTANT RISK FACTOR for ANEURYSM FORMATION
ATHEROSCLEROSIS
Screening of ABDOMINAL AORTA is done in ______ after age _____
UK
> 65 years
Why screening of ABDOMINAL AORTIC ANEURYSM is done?
⭐ Common above age > 65yrs
⭐ whether Critical diameter is reached or not
Critical diameters of ANEURYSMS:
⭐ Critical diameter of POPLITEAL ARTERY ANEURYSM
⭐ Critical diameter of ABDOMINAL AORTIC ANEURYSM ♀️
⭐ Critical diameter of ABDOMINAL AORTIC ANEURYSM ♂️
⭐ Critical diameter of ASCENDING THORACIC AORTIC ANEURYSM
⭐ Critical diameter of DESCENDING THORACIC AORTIC ANEURYSM
⭐ Critical diameter of ASCENDING THORACIC AORTIC ANEURYSM in MARFAN’S SYNDROME & BICUSPID AORTIC VALVE
⭐ Critical diameter of POPLITEAL ARTERY ANEURYSM
🎯 2-3cm
⭐ Critical diameter of ABDOMINAL AORTIC ANEURYSM ♀️
🎯 5cm
⭐ Critical diameter of ABDOMINAL AORTIC ANEURYSM ♂️
🎯 5.5cm
⭐ Critical diameter of ASCENDING THORACIC AORTIC ANEURYSM
🎯 5.5cm ➕ Rate of increase in size > 0.5 cm/yr
⭐ Critical diameter of DESCENDING THORACIC AORTIC ANEURYSM
🎯 6 cm ➕ Rate of increase in size > 1 cm/yr
⭐ Critical diameter of ASCENDING THORACIC AORTIC ANEURYSM in MARFAN’S SYNDROME & BICUSPID AORTIC VALVE
🎯 4.5-5cm
CLINICAL features of ABDOMINAL AORTIC ANEURYSM
- ASYMPTOMATIC
- ABDOMINAL Pain
- PULSATILE Mass
- EMBOLUS Formation ➡️ Blue toe SYNDROME
- Rupture ➡️ High Mortality
Blue Toe Syndrome
Showeringbof Embolus From ABDOMINAL AORTIC ANEURYSM to Foot
⬇️
Gangrene in toes
🩺 IOC of AAA
🩺 SCREENING IOC of AAA
🩺 IOC of AAA
🎯 CT ANGIOGRAPHY
🩺 SCREENING IOC of AAA
🎯 USG
INDICATIONS for SURGICAL INTERVENTION IN AAA
⭐ SYMPTOMATIC
⭐ Asymptomatic ➕ Size > 5.5 cm
SURGICAL INTERVENTION IN AAA
- EVAR (EndoVascular Aneurysmal Repair)
- OPEN SURGERY
🚫 CONTRAINDICATION of EVAR
- Difficult ILIAC AXIS
- ⬆️ ANGULATION
Identify
EVAR Stent
Why Lifelong monitoring after EVAR is needed?
Chances of ENDOLEAK
(Leak from EVAR)
Identify
EVAR in place
Types of ENDO-LEAKS
⭐ Type 1 ENDOLEAK MOST COMMONLY SEEN IN
⭐ Type 2 ENDOLEAK MOST COMMONLY SEEN IN
⭐ Type 1 ENDOLEAK MOST COMMONLY SEEN IN
🎯 THROCIC AORTIC ANEURYSM
⭐ Type 2 ENDOLEAK MOST COMMONLY SEEN IN
🎯 ABDOMINAL AORTIC ANEURYSM
Which GRAFT is used in OPEN SURGERY for AAA?
Dacron Graft
MATTOX PROCEDURE
🧠⚡LLRM ⚡
LEFT MEDIAL VISCERAL ROTATION
Left Descending Colon is ROTATED Medially
⬇️
Expose AORTA
CATTLE-BRASCH MANEUVER
🧠⚡CRRI ⚡
RIGHT ASCENDING COLON is ROTATED INTERNALLY (MEDIALLY)
⬇️
EXPOSES THE IVC
KOCHERIZATION
Mobilization of DUODENUM
⚡⚡ MOST COMMON CAUSE of DEATH AFTER ABDOMINAL AORTIC ANEURYSM SURGERY
Cardiovascular causes
COMPLICATIONS of AAA SURGERY
- Renal failure
- Aorto-Duodenal Fistula: Upper GI hemorrhage & Melena
- Colonic Ischemia: Lt side of colon
IMA is involved. - PARAPARESIS
Cause of PARAPARESIS after AAA Surgery
Involvement of ARTERY OF ADAMKIEWICZ
⬇️
Supplies Anterior Spinal Artery
Upper GI HEMORRHAGE: Hemetemesis (OR) Melena
➕
H/O AAA Surgery
Aorto-Duodenal Fistula
🧑🏻⚕️ Clinical Features of RUPTURED AORTIC ANEURYSM
- Shock
- Pulsatile swelling
- Flank Pain
⚡⚡ MOST COMMON site of BLEEDING accumulation in ruptured AAS
Left Retroperitoneum
🩺 IOC for RUPTURED AAA
CT ANGIOGRAPHY
💊💉 MANAGEMENT of RUPTURED AAA
Dacron Graft Repair
RUPTURED AAA
CRAWFORD Classification is used for
THORACO-ABDOMINAL AORTIC ANEURYSM
⚡⚡ MOST EXTENSIVE TYPE OF THORACO-ABDOMINAL AORTIC ANEURYSM
Type 2
(From Left SUBCLAVIAN ➡️ Aortic Bifercation (iliac artery)
Causes of THORACIC AORTIC ANEURYSM
- 2deg to ATHEROSCLEROSIS
- MARFAN Syndrome
- Ehler Danlos Syndrome
🧑🏻⚕️ Clinical Features of THORACIC AORTIC ANEURYSM
- ASYMPTOMATIC
- HOARSENESS ➡️ ORTNER’S Syndrome
- DYSPHAGIA
- DYSPNEA
- RUPTURE
Cause of HOARSENESS IN THORACIC AORTIC ANEURYSM
Pressure of DESCENDING THORACIC ANEURYSM on LEFT RECURRENT LARYNGEAL NERVE
⬇️
ORTNER SYNDROME
🧑🏻⚕️ Clinical Features of RUPTURED THORACIC AORTIC ANEURYSM
- DYSPNEA
- LEFT SIDED PLEURAL EFFUSION
💊💉 MANAGEMENT of THORACIC AORTIC ANEURYSM
- Symptomatic
- ASYMPTOMATIC patients with
✨ ASCENDING diameter: 5.5cm
✨ DESCENDING diameter: 6cm
✨ MARFAN SYNDROME: 4.5-5cm
⬇️
- EVAR
- OPEN GRAFT REPAIR
⚡⚡ MOST COMMON RISK FACTOR FOR AORTIC DISSECTION
Hypertension
⚡⚡ MOST COMMON SITE FOR AORTIC DISSECTION
Lateral wall of ASCENDING THORACIC AORTA
🧑🏻⚕️ Clinical Features of AORTIC DISSECTION
🧠⚡ 5th DECADE MALE⚡
- Chest Pain RADIATING to BACK in INTERSCAPULAR Region
- Aortic & Coronary Insufficiency
Chest Pain of AORTIC DISSECTION
⭐ Chest Pain
⭐ RADIATING to BACK in INTERSCAPULAR Region
🩺 IOC for AORTIC DISSECTION
⭐ IN STABLE PATIENT
⭐ IN UNSTABLE PATIENT
⭐ IN STABLE PATIENT
🎯 CT ANGIOGRAPHY
⭐ IN UNSTABLE PATIENT
🎯 TRANS-ESOPHAGEAL ECHO
Identify
🧠⚡ identify line in the aorta⚡
CT ANGIOGRAPHY of AORTIC DISSECTION
Chest X-RAY of AORTIC ANEURYSM
- Widening of CHEST
- Left sided PLEURAL EFFUSION
Widening of MEDIASTINUM
- THORACIC ANEURYSM
- ABDOMINAL ANEURYSM
- AORTIC DISSECTION
DeBakey classification used for
Aortic DISSECTION
Stanford Classification used for
Aortic Aneurysm
💊💉 MANAGEMENT of AORTIC DISSECTION
- Permissive Hypotension: ESMOLOL
- Grade 1 & 2 DeBakey: Graft Repair
- Grade 3 DeBakey:
✨ Progressive symptoms: Surgery
✨ Chronic: Conservative Management
POPLITEAL ANEURYSM
🧑🏻⚕️ CLINICAL FEATURES
- Pulsating Swelling of Knee
- Loss of Contour in the KNEE Behind
- Pain & Distal Emboli
Identify
Popliteal Aneurysm
🩺 IOC for POPLITEAL ANEURYSM
CT ANGIOGRAPHY
INDICATION for INTERVENTION in POPLITEAL ANEURYSM
- ASYMPTOMATIC with DIAMETER > 2 cm
- All SYMPTOMATIC PATIENTS
Cause of FEMORAL ARTERY ANEURYSM
Puncture of the vessels
Critical Diameter for FEMORAL ANEURYSM
3cm
Identify
Femoral aneurysm
💊💉 MANAGEMENT of FEMORAL ANEURYSM
< 3cm: Thrombin Injection (USG Guided)
≥ 3cm: Surgical Repair
DOC for Raynaud’s Phenomenon
Calcium Channel Blockers
Difference BETWEEN Raynaud’s Phenomenon & Acrocyanosis
1° RAYNAUD’S vs 2° RAYNAUD’S
Cause of SUBCLAVIAN STEAL SYNDROME
Stenosis in 1st PART of SUBCLAVIAN ARTERY
⬇️
On EXERCISING, Retrograde flow from VERTEBRAL Artery to side of Lesion ➡️ To SIDE of LESION
⬇️
Less Blood Flow to Brain
⬇️
Syncope & DIZZINESS
🩺 IOC of SUBCLAVIAN STEAL SYNDROME
CT ANGIOGRAPHY
💊💉 MANAGEMENT of SUBCLAVIAN STEAL SYNDROME
Angioplasty of stenosed segment
⚡⚡ MOST COMMON SITE OF CAROTID ARTERY STENOSIS
Bifurcation
⚡⚡ MOST COMMON CAUSE OF CAROTID ARTERY STENOSIS
Atherosclerosis
🧑🏻⚕️ Clinical Features of CAROTID ARTERY STENOSIS
- Asymptomatic
- Amaurosis Fugax
- Dysphasia
- TRANSIENT ISCHEMIC ATTACK
🩺 IOC for CAROTID ARTERY STENOSIS
Duplex scan
INDICATION for Surgery in CAROTID ARTERY STENOSIS
≥ 70% Stenosis ➕ any of the following
- Amaurosis fugax
- C/L Facial Paralysis
- Arms/Legs Paralysis
- Hemianopia
- Dysphasia
💊💉 MANAGEMENT of CAROTID ARTERY STENOSIS
⭐ CAROTID END-ARTERECTOMY
⭐ Angioplasty or GRAFTING
Thoracic OUTLET SYNDROME
Blockage of outlet of thoracic outlet
⭐ Subclavian ARTERY ➡️ Cold fingers, Pallor, Raynaud’s Phenomenon
⭐ Subclavian VEIN ➡️ Swelling
⭐ BRACHIAL PLEXUS
CAUSE OF THORACIC OUTLET SYNDROME
- Cervical Rib
- Arthritis
- Tumours
🧑🏻⚕️ Clinical Features of THORACIC OUTLET SYNDROME
Arterial: Distal Gangrene & Claudication
Venous: SUBCLAVIAN or Axillary Vein Thrombosis
Neural symptoms: Symptoms of ULNAR aspect of hand
🩺 IOC for THORACIC OUTLET OBSTRUCTION
CT ANGIOGRAPHY
PROVOCATIVE TESTS FOR THORACIC OUTLET SYNDROME
🧠⚡ WAR-HAL⚡
- Wright / Hyper-abduction Test
- ADSON Test
- ROOS Test
- HALSTEAD’s maneuver
➕ ADSON’S TEST
⬇️ or ⛔ I/L RADIAL PULSE
Identify
ADSON’S TEST
Identify
WRIGHT TEST
Identify
ROOS TEST
(OR)
EAST test (Elevated Arm Stress Test)
Identify
Elvey or ULTT (Upper Limb Tension Test)
💊💉 MANAGEMENT of THORACIC OUTLET SYNDROME
- If Cervical Rib ➕ ➡️ RESECTED
- Physiotherapy
- Arterial Blockade: Angioplasty & Stenting
- Venous Thrombosis: Anticoagulants
Identify
CRISCOID ANEURYSM
CRISCOID ANEURYSM
AV Malformation involving the SUPERFICIAL TEMPORAL VESSELS
Vascular Pulsatile Swelling
➕
Compressible
CRISCOID ANEURYSM
💊💉 MANAGEMENT of CRISCOID ANEURYSM
Surgical management (OR) EMBOLIZATION
AV Fistula
Causes
- Traumatic
- Iatrogenic
- Congenital
⚡⚡ MOST COMMON AV FISTULA
Iatrogenic AV Fistula
⬇️
Dialysis
Renal DIALYSIS AV FISTULA
Cimmino-fistula
Radio-cephalic fistula
BETWEEN
Radial Artery & Cephalic Vein
Congenital AV FISTULA seen in
⭐️BSP⭐️
- Parke Weber Syndrome
- Beckwith Wiedmann Syndrome
- Sturge Weber Syndrome
If CONGENITAL FISTULA ➕ in LIMB, leads to
HYPERTROPHY OF LIMB
🧑🏻⚕️ Clinical Features of CONGENITAL AV FISTULA
- Pulsatile Swelling
- Palpable Thrill
- Bruit ➕
AV FISTULA in long term leads to development of
High OUTPUT CARDIAC FAILURE
NICOLADONI (OR) BRANHAM SIGN
Seen in
⭐ AV FISTULA
⭐ BP HIGH ➕ LOW HEART RATE
⭐ Press the feeding vessel of Av fistula
⬇️
Size of fistula ⬇️
Pulse rate ⬇️
Thrill/Bruit ⬇️
Systolic BP ⬆️⬆️
🩺 IOC of AV FISTULA
MR ANGIOGRAPHY > Digital subtraction ANGIOGRAPHY
💊💉 MANAGEMENT of AV FISTULA
- Embolization
- Surgical Ligation
Chest X-RAY findings of AORTIC DISSECTION
🧠⚡D WEEBS ⚡
D: Dilated aortic arch
W: Widened mediastinum
E: Effusion (pleural)
E: Effusion (pericardial)
B: Blurring of aortic contour
S: Separation of intimal calcification