Arterial Syndromes Flashcards
Define a syndrome?
the signs, symptoms or other manifestations to constitute the characteristics of a a morbid entity
Where does SSS begin?
with a stenosis near the origin of the subclavian artery or the innominate artery on the right side
Where does the pressure in the subclavian atery fall?
falls below that of the junction of the 2 vertebral arteries at the base of the brain
What is the downside is the retrograde flow of blood in the vertebral artery?
artery may cause a reduction in flow to the brain resulting in symptoms of vertebrobasilar insufficiency
What occuts in left sided SSS?
- ipsilateral
- contralateral
- the left vertebral has retrograde flow ,the contralateral vertebral and CCA will have increased flow
Right sided innominate artery stenosis?
- results have a far greater impact on cerebral hemodynamics because of the additional involvement of the right CCA
- The right CCA will have a lower perfusion pressure as a result of the proximal innominate artery stenosis
Accuracy of using doppler to diagnose SSS?
90-100% accurate
Whats the key to successfully diagnosing SSS?
- Reversal of flow in the vertebral artery
What is the final stage of SSS?
the reversal of flow in the vertebral artery
Define incomplete SSS?
Prior to constant flow reversal there is a deceleration of antegrade flow during systole with retrograde flow only in diastole
How is impending reversal of flow seen on doppler? (SSS)
Bunny sign
What is reactive hyperemia of the forearm?
- In cases where the vertebral artery is oscillatory rather than frankly retrograde, brachial artery compression with a blood pressure cuff should result in reduced retrograde and increased antegrade flow in the affected vertebral artery
- When the cuff is deflated,the pattern will show marked reversal of flow
Clinical symptoms of patients with SSS?
a loud supraclavicular bruit and always a reduced pulse and blood pressure in the affected arm
Blood pressure in SSS?
- A pressure difference greater than 20 mm Hg between the arms is a good indicator that a SSS may be present(impending steal)
- The ipsilateral arm will have decreased pressure
- The brachial artery pressures should be measured in order to complete the diagnosis
Where is blood shunted in a vertebral occlusion?
the thyrocervical and costocervical trunks of SCA
What occurs in the contralateral vertebral artery in a vertebral artery stenosis?
Compensatory enlargement of the opposite Vertebral artery occurs
Define thoracic outlet syndrome? (TOS)
- type of syndrome
- may contribute to
potential to effect
- entrapment syndrome that may contribute to various degrees of limb ischemia
- There is the potential effect of compressing the subclavian artery or vein and the brachial nerve plexus
TOS S/S?
- Patient presents with an upper extremity circulatory problem
- Such as cold, painful, or numb extremities
- It May vary with limb positioning
What is TOS bounded by? (3)
- Clavicle
- 1st rib
- scalene muscle
Define Paget-Schroetter syndrome?
- refers to effort-induced DVT of the upper extremity veins in young patients
- classifies as a thoracic outlet syndrome
How does TOS present?
- may injure? causing?
- typically in that arteries?
- Restriction at the thoracic outlet causes the vessels or nerves to be partially or completely compressed when the arm is in certain positions
- Repeated irritation may injure the intima causing thrombus formation
- Arterial emboli from thrombus can travel to distal parts of the arm usually from subclavian or axillary arteries
Uncomplicated TOS? (2)
No thrombus, plaque, or aneurysm formation
It May be caused by nerve compression
How is TOS diagnosed?
- Segmental BP’s and pulse volume waveforms are obtained with the limb in neutral position
How are BP’s obtained in TOS?
- proximal and distal brachial artery levels
- The test is repeated with patient’s arm in the position that causes the symptoms ie-just brushing the hair may cause discomfort
- The test is repeated with the head and arms in extreme positions
- A change in the BP’s or PVR’s should occur
Entrapment syndromes? (2)
- mechanical compression
2. congenital malformations
Mechanical compression?
The mechanical compression of an artery by the skeletomuscular system, tumor, or inflammatory mass may cause the patient to present with similar symptoms
Congenital malformations?
involving the arterial system or trauma to the extremities may produce localized ischemia because of mechanical compression or entrapment
Popliteal artery entrapment?
- A common site especially in young athletes for one form of mechanical compression is the popliteal artery behind the knee joint
- Hyperextension of the knee or active plantar flexion of the foot may result in diminished flow to the calf and foot
- This is because of popliteal artery compression by the medial head of the gastrocnemius muscle
In popliteal entrapment syndrome patients demonstrate?
- a drop of at least 20mmHg pressure and reduced tibial artery velocities when the artery is compressed
In popliteal entrapment syndrome patients demonstrate?
- a drop of at least 20mmHg pressure and reduced tibial artery velocities when the artery is compressed
Anterior compartment syndrome?
- Another site where trauma-ie sport injuries and motor vehicle accidents resulting in leg fractures occurs
- This may result in arterial compression and subsequent ischemia distal to the site of arterial compression
What is one of the frequent manifestations of tissue ischemia?
Blue toe syndrome
What is blue toe syndrome caused by? who does it mainly affect?
- occlusion of small vessels, and usually occurs in elderly men who undergo an invasive vascular procedure
- The blockage is usually caused by either cholesterol crystals or a lump of plaque getting stuck in the small vessels
Development of blue toe syndrome?
- Develops suddenly and rapidly
- It may affect one or more toes but is usually confined to one foot
- If left untreated, gangrene can set in
Diagnosis of blue toe syndrome?
- Usually, there will be a problem further up the arterial tree in one of the proximal blood vessels such as an aneurysm or plaque deposits- atherosclerosis
- Ultrasound and CT angiograms are used to diagnose
Treatment for blue toe syndrome? (3)
- stenting
- bypass surgery
- anti-coagulants and anti-platelet therapy
What is stenting?
a mesh tube is inserted into a blood vessel to hold it open and prevent restriction of blood flow
What is bypass surgery?
blood flow is diverted around major arteries that are narrow or partially blocked
What is anti-coagulants and anti-platelet therapy?
these can help in the short term but are associated with a high recurrence rate of blue toe syndrome
Define Raynaud’s syndrome?
- causes some areas of your body such as, your fingers and toes to feel numb and cold in response to cold temperatures or stress
- Smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm)
Who does Raynaud’s syndrome typically affect?
Women are more likely than men to have Raynaud’s disease and those living in colder climates
Treatment of Raynaud’s disease?
depends on its severity and whether you have other health conditions
Raynaud’s S/S?
Cold fingers or toes
Color changes in your skin in response to cold or stress
Numb, prickly feeling or stinging pain upon warming or stress relief
a sore, ulcer, or infection may develop
Raynaud’s colour changing pattern?
- White/blue/red
- Affected areas of your skin usually first turn white
- Then, the affected areas often turn blue and feel cold and numb
- As you warm and circulation improves, the affected areas may turn red, throb, tingle or swell
Primary Raynaud’s?
The most common form
Not the result of an underlying associated medical condition that could provoke vasospasm
Secondary Raynaud’s?
Less common form , caused by an underlying problem
It tends to be more serious due to the underlying disease/condition
Secondary Raynaud’s S/S?
- 40 years of age or older
causes of secondary Raynaud’s?
- connective tissue disease
- atherosclerosis, hypertension, Bueger’s disease
- carpal tunnel, repetitive strain injury
Diagnosis of Raynaud’s?
- cold simulation test
Steps:
1. A small temperature-measuring device is attached to your fingers with tape
- Your hands are placed in ice water to trigger symptoms, and then removed
- The measuring device records how long it takes your fingers to return to normal body temperature
4,. Arterial study of the upper extremity to R/O obstruction or thoracic outlet syndrome may be done prior
Nutcraker syndrome?
- Vascular compression disorder
- compression of the left renal vein between the superior mesenteric artery and aorta
What can Nutcracker syndrome lead to?
- to renal venous hypertension, resulting in rupture of thin-walled veins into the collecting system with resultant hematuria
- Since the left gonad drains via the left renal vein it can also result in left testicular pain in men or left lower quadrant pain in women
Nutcracker syndrome should be routinely excluded as a possible cause of? (2)
varicocele and pelvic congestion
Nutcraker syndrome sono signs?
Lt renal enlargement, persistent hematuria, proteinuria and hypertension and RV thrombus
Nutcracker syndrome Treatment?
- Nephrectomy
- nephropexy
3, renocaval reimplantation - intravascular stent
Leriche syndrome?
- blockage in the lower part of the aorta just before the starting point of the common iliac arteries
- Blood supply to the lower limbs and the groin is reduced
risk factors of leriche syndrome?
Atherosclerosis and smoking
Leriche syndrome 3 main symptoms?
- Claudication of the buttock area (pain or cramps that develop with increased walking or exercise)
- Impotence i.e. failure to achieve or maintain an erection in males
- Decreased pulses in the lower limbs
How to diagnose Leriche syndrome?
- The Ankle Brachial Index helps in the diagnosis of Leriche syndrome
- A complete arterial doppler study of the Aorta/iliac region and the peripheral arteries should be done
- The distal aorta and bifurcation will be occluded
- The peripheral arteries need to be assessed in the event of a bypass surgical procedure as treatment allows blood flow to the lower limbs
Define Marfan’s syndrome?
Genetic disorder that affects the body’s connective tissue-75% of the patients inherit this
Marfan’s syndrome affects what parts of the body? (5)
- heart
- blood vessels
- bones
- joints
- eyes
complications of marfan’s syndrome?
- Aortic aneurysm
- dissection
- Mitral valve prolapse
