Arterial Syndromes (SSS, TOS, Entrapment, P-SS, Blue Toe, Raynauds, Nutcracker, Leriche, Marian’s)

Question 1

What is the worst scenario for SSS (artery involvement) in terms of impact on cerebral hemodynamics & why

Answer 1

RT sided INN A because of the additional involvement of right CCA

Question 2

In SSS, what happens with brachial A BP?

Answer 2

Decreased ipsilateral brachial artery systolic BP - (20-40 mmHg pressure difference between arms)

Question 3

In SSS, describe SCA flow changes (in stenosis & downstream) on affected side

Answer 3

High PSV >400 cm/s (or occluded completely)
Loss of tri-phasic signal (due to drop in pressure and flow)
Aliasing
Damped flow distally (monophonic)

Question 4

In SSS, where will you see increased flow? What does this maintain?

Answer 4

Increased flow in the contralateral (opposite side) VA and CCA
Maintain pressure in Circle of Willis

Question 5

What is the (final stage) and key to successfully diagnosing the presence of SSS?
What blood flow pattern will you see before this?

Answer 5

Reversal of flow in VA

Prior there is a deceleration of antegrade flow during systole with retrograde flow only in diastole

Question 6

Brachial artery compression results in (2) in VA and what happens upon cuff deflation

Answer 6

Brachial artery compression =
reduced retrograde and increased antegrade flow
Cuff deflation = reactive hyperaemia

Question 7

T/F if VA is occluded, flow is shunted to (2)

Answer 7

Thyrocervical and costocervical trunks

Question 8

Compression of the Subclavian artery between the first rib and the scalene muscle may result in

Answer 8

Thoracic outlet syndrome

Question 9

Thoracic outlet is bounded by which (3)

Answer 9

Scalene muscle
1st rib
Clavicle

Question 10

What effect may thoracic outlet syndrome have (2)

Answer 10

Compress SCA

Compress brachial nerve plexus

Question 11

What is considered an upper extremity DVT?

Answer 11

Pager-Schroetter syndrome

Question 12

Thoracic outlet syndrome complications (3)

Answer 12

Thrombus
Plaque
Aneurysm

Question 13

What is expected to occur to confirm thoracic outlet syndrome

Answer 13

A change in BP or pulse volume recording (PVR) - SCA will look like a tardus parvus

Question 14

What 2 things occur with popliteal artery entrapment syndrome?
How does it happen

Answer 14

Popliteal artery compressed by medial head of the gastrocnemius
Pressure drop by at least 20 mmHg & reduced tibial artery velocities

Question 15

Two common areas of entrapment syndrome

Answer 15

Popliteal artery

Anterior tibial

Question 16

BLUE TOE syndrome usually occurs in: -what population

• blockage caused by what (2)
• onset of syndrome
• complication (1)
• treatment (3)

Answer 16

Older men
Cholesterol crystals/lump plaque 
Rapid 
Gangrene
Tx: stunting, bypass surgery, anti-coagulants/anti-platelet (high recurrence rate)

Question 17

Raynauds syndrome:
What (order of colour
Who
Where

Answer 17

Numb/cold fingers/toes in response to cold - white/blue/red

Women in colder climates

Question 18

Nutcracker syndrome is the compression of the ____ between the ___ and ____

Answer 18

Left renal vein

Between SMA & aorta

Question 19

Nutcracker syndrome is associated with (5)

Answer 19

Renal venous HTN
Hematuria of collecting system vessels
Lower quadrant pain (women)/testicular pain (men)
Nausea/vomiting
Varicocele formation

Question 20

LERICHE syndrome:
Area of blockage
Risk factors (2)
3 main symptoms*
What helps with diagnosis

Answer 20

• Area: Lower aorta-common iliacs
• RF: Smoking + atherosclerosis
• S/S: Claudication of buttock (pain with walking), impotence, decreased pulses in lower limbs
• Diagnosis: Ankle Brachial index

Question 21

Marfan’s syndrome

• Cause
• Areas it affects
• Complications
• Pt phenotype

Answer 21

• Cause: genetic
• Areas it affects: targets connective tissue (so can be anywhere: heart, blood vessels, bones, joints, eyes)
• Complications: aortic aneurysm, dissection, mitral valve prolapse
• Pt phenotype: long arms/legs/fingers