Arterial Disorders Flashcards
Most common causes of peripheral arterial occlusive disease?
- Atherosclerosis
- Buergers disease
- Arteritis: Takayasu disease, SLE
- Post traumatic: Direct injury, Radiation
what is Aortoiliac occlusive disease?
Aortoiliac occlusive disease is caused by atherosclerosis extending from the distal aorta through the iliac arteries and may b Upto femoral level
signs and symptoms of Aortoiliac occlusive disease?
- Bilateral thigh or buttock claudication
- Erectile dysfunction
- Absent or diminished pulses, distal to occlusion
- Distal ischemia rest pain and tissue Loss is rarely encountered
Leriche syndrome
it refers to traid of buttock and thigh claudication, absent femoral pulses, and impotence (males)
Diagnosis of Aortoiliac occlusive disease?
- Color Doppler study is first investigation of choice
- CT angiography is the investigation of choice
- Angiography is the gold standard investigation
Treatment for Aortoiliac occlusive disease?
Limb revascularization techniques like:
- Aortobifemoral bypass
- Aortic endarterectomy
- Axillofemoral bypass
- Iliofemoral bypass
- Femorofemoral bypass
most common source of embolus
Heart(80-90%)
The clot(embolus) most frequently originates from the left atrium
clinical presentation of acute lower extremity ischemia is?
“5Ps” describe:
- Pain
- Pallor
- Paralysis
- Paresthesia
- Pulselessness
diagnoses of acute thromboembolism?
- Color Doppler
- Angiography/CT angiography
Treatment for acute arterial occlusion?
it needs rapid diagnosis and immediate surgical correction of occlusion. This involves:
- Heparin
- Embolectomy
- Bypass revascularization
- Thrombolytic therapy ( tissue plasminogen activator or urokinase
- EMBOLECTOMY is the treatment of choice for acute embolism
What is buergers disease?
It is also called as Thromboangiitis obliterans (TAO)
It is a segmental inflammatory, nonatherosclerotic, occlusive vascular disease that most often affect the small and medium sized arteries in the distal upper and lower extremities (Lower> Upper).
- The inflammatory process also involves the neighbouring veins and nerves
symptoms of TAO?
Triad of symptoms seen in TAO:
- claudication
- Raynaud’s phenomenon
- Migratory superficial vein thrombophlebitis
- claudication primarily confined to calves and feet or forearm and hands because TAO primarily affects distal vessels
Investigation of TAO?
- Color Doppler study is the first investigation of choice
- Arteriography is helpful in making the diagnosis which shows disease confined to distal circulation usually infrapopliteal and distal to the brachial artery
- Biopsy is rarely needed but is the only means to establish a definitive diagnosis
How do you distinguish TAO from other vasculitis pathologically?
it’s is distinguished from other forms of vasculitis by a highly cellular inflammatory intraluminal thrombus with relative sparing of the vessel wall and more specifically sparing of internal elastic lamina
Medical management of TAO?
- Smoking cessation is only definitive therapy. Bupropion or Varenicline can be used as smoking cessation aids.
- Iloprost is a prostaglandin analog used to manage pain associated with TAO
- Calcium channel blockers such as nifedipine, nicardipine, oramlodipine used to manage vasospasm associated with TAO
- intermittent pneumatic compression: to enhance calf inflow in patients with intermittent claudication or critical limb ischemia
