atherosclerosis and aneurysms Flashcards by abbie anderson

______ is A chronic disease in which thickening, hardening, and loss of elasticity of the arterial walls result in impaired blood circulation. It develops with aging, and in hypertension, diabetes, hyperlipidemia, and other conditions.

Arteriosclerosis (median part of artery (smooth muscle wall))

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________ is a A form of arteriosclerosis characterized by the deposition of atheromatous plaques between the intima and media layers of the arterial walls of large and medium-sized arteries. These plaques contain cholesterol and lipids.

Atherosclerosis - can build up until you rupture the intima.

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what complications are associated w/ atherosclerosis

1) Thrombus – blood clot
2) Embolus – mass of undissolved matter moving in the blood stream, solid (you get fat in the blood vessel from trauma)- clot, fat, liquid – pus, water, gaseous - air
3) Stenosis - narrowing
4) Occlusion - blockage
5) Aneurysm – abnormal dilation of a blood vessel

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what happens w/ atherosclerosis?

Loss of arterial compliance
•
Stiff arteries – Arteriosclerosis is characterized by the tunic media losing its elasticity. The artery then loses its compliance, its ability to dilate to accommodate an increase in blood volume as well as its ability to contract/snap back to its normal diameter thus propagating or transmitting the wave of blood.
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In anyone with decreased arterial compliance the heart at systole will eject blood into the rigid system slower than into a more compliant one and peak arterial pressure will occur late in systole. This causes stress on the pumping organ, heart, and an increase in systemic BP.
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Increased intraluminal resistance; narrowing of lumen
•
Plaques
Both lead to decrease profusion of an organ/tissue

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what are these risk factors?

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Hyperlipidemia
Diabetes
Smoking
Family history or genetic disposition

atherosclerosis

Not only life style choices affect your vascular health but family history or genetic disposition plays a large role in how, when and if Cardio Vascular disease directly affects ones life. Some people can drink, smoke and carouse around their whole life and end up dying of old age at 90 years old. While some people end up with liver cirrhosis or lung cancer at an early age. We are NOT all created equal.

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what clinical findings are associated w/ atherosclerosis?

Think multi-organ
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Asymptomatic
Hypertension: Kidneys
Heart attack: Heart
Stroke: Brain
Aneurysms: Brain, AO, branch vessels
Claudication: Legs
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Total loss of profusion: Various Infarctions: Brain, Heart, Kidneys, Toes are the most common

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what will u find sonographically w/ atherosclerosis

Thickening of intimal lining
•
Intimal irregularities
Plaques
Shadowing
Non-shadowing
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Calcifications
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Tortuosity

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which one is normal?

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what is this?

Ectasia = Mild dilation of tubular structure
Notice how the vessel diameter increases and decreases, giving an hour glass or a double bulge appearance.
Measurements will not exceed 3cm in diameter and there is not tapering of the abdominal aorta.

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Is it uncommon to see an AO go from one side of the spine to the other.

no. its common - Tortuous or Serpiginous = twisting, winding, or crooked:

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what is A localized, pathological, blood-filled dilatation of a blood vessel caused by a disease or weakening of the vessel’s wall?

Aneurysms
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Be aware that you can have multiple aneurysms with in the same blood vessel

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a _____ aneurysm is the Most common type of abdominal aorta. Usually occurs in distal aorta and can extend into iliac

fusiform (true - hole aorta gets widened, most common)

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a _____ aneurysm
More spherical in shape
•
Connected to vessels by a neck

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Saccular (true)

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____ is 2 adjacent fusiform aneurysms

dumbell shaped aneurysm

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a ____ aneurysm is An inflammatory response 2o to a fungal or other microorganisms. Mycotic aneurysms are a result of an infection weakening the vessel wall.

Mycotic

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what type of anuerysm?

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what type of aneurysm

fusiform

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what is this?

saccular aneurysm

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what type of aneurysm involves all layers.

true

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what has Dilatation of an artery, but not involving all the wall layers

false/pseudo

May not involve dilatation of any wall, i.e. typically occur after arterial puncture/trauma. For example the femoral artery after an angiogram, when direct pressure isn’t applied over the puncture site and blood is allowed to escape into the surrounding fascia of the thigh. The fascia doesn’t allow the much extravasation of blood.

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what is this?

pseudoaneurysm

During systole blood flows into the PA. In diastole blood flows back into the supplying vessel.

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describe the flow.

This type of flow is termed To and Fro flow. Notice the systolic and diastolic flow directions.

Diastolic flow is below the baseline as the pressure in the PA is higher than in the supplying vessel.

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name a few clinical signs of an aneurysm

Asymptomatic – Slow Growing
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Can have back pain, abdominal pain or leg pain once expansion begins
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Incidental finding on abdominal x-ray – calcifications in AAA
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Pulsatile mid abdominal mass on physical exam
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Abdominal bruit (brew E)– French for noise

____ is Often seen in larger aneurysms
Presence may diminish vascular pulsations

what else might be seen in us?

thrombus

Make sure thrombus is not dissection of wall

Signs of atherosclerosis are often present
Dilation: Fusiform, Saccular or bulbous in shape
Focal or Diffuse

what do you see here?

aneurysm

what can you see here?

thrombosis

aneurysm. Size \>\_\_\_\_ is + for diagnosis • Loss of the normal taper from diaphragm to umbilicus Note location (AAA) to renal arteries – Above RA = _____ morbidity and mortality – Lt. RV marks lowest extent of Lt. RA - How can you tell were the LRV is? • Measure ____ wall to _____ wall • Measure as _____ to the artery as possible • Check extent of aneurysm – ? Iliac involvement • Color Doppler to help define thrombus and to see if there is dissection

3 cm increased outer, outer perpendicular

Which line is the correct plane and level to make an accurate measurement

the red is most accurate

what are the indications for surgery for an aneurysm

– \> 5cm in diameter or \> 5mm /yr growth – Iliac or femoral involvement – Embolic source

describe the Post repair appearance of an aneurysm –

Often graft material is echogenic – May be placed within native AO or to the side of native AO – Thrombosis is often seen surrounding graft material

what are teh common types of grafts?

what might this be?

Aneurysm • Post repair appearance

what has Separation of layers, intima and media, of the aortic wall • Most commonly in the thoracic aorta (Why do you think) • Mild to no dilation of the aorta

Aneurysm • Dissection doesn't have to go to the end of the vessel, intima generally gets pulled away. most common in the arc b/c fastest flow. you would see an extra layer in the aorta not a bubble

the ____ model Best known classification system, other systems do exist. what are the 3 classifications

DeBakey Model Type 1: Involves ascending and arch of the AO, can extend into descending, common. • Type 2 (Marfan’s): Local dissection without extension. Ascending and arch involved. Uncommon, associated with Marfan’s syndrome. Mean age of death 32, 93% secondary to CV problems. -- eventually have an aortic aneurysm • Type 3: Involves descending AO and extends into abdominal AO, common, low mortality, good prognosis

what clinical associaitons are there with dissection?

Etiology (cause): Unknown – Hypertension – Cystic Medial Necrosis disease • fragmentation of elastic fibers and accumulation of mucoid substance in the media of the arterial wall. Associated with Marfan’s, but also with advanced age and chronic HTN. – Congenital Cardiac Anomalies – Pheocromocytoma (Adrenal medullary tumor, secretes epinephrine) – Catheter induced needle wounds

wht clinical signs are associated w/ dissection?

Intense chest pain, “tearing”, rapid onset – Abdominal pain – Pain in low back – Pain in arms and legs – Vomiting – Paralysis, transient blindness, confusion, syncope, headache, lack of extremity pulses

what is this?

aortic dissection aneurysm Intimal flap • Thin, echogenic line inside AO • Flap moves with blood flow http

what do you see here? what do you need to do w/ you 2d and color ?

– Intimal flap can be mistaken for AAA hematoma – Use Color Doppler Higher scale • Lower gain Gain setting Too high Too low Reduce color artifact

\_\_\_\_\_ is the Discontinuation of the Aortic wall • Typically infra renal and left lateral location

aortic rupture

what clinical signs: vascular collapse are there associated w/ aortic rupture?

– More common in pt. with AAA – Hypotension – Back Pain – High mortality rate

describe teh sonographeic appearance of an aortic rupture

Hematoma associated with aneurysm located anywhere in the retroperitoneum. – Echogenicity is variable – Size is variable – Palpation is helpful

\_\_\_\_\_\_\_ is is a variant of atherosclerotic aneurysm that is characterized by inflammatory and/or fibrotic changes in the periaortic regions of the retroperitoneum.

Inflammatory aneurysm of the abdominal aorta (IAAA) These inflammatory and/or fibrotic changes are probably the result of a local autoallergic reaction to certain components of atherosclerotic plaques. •This distinct entity has important implications, as the periaortic fibrotic tissue adherent to ureters, the duodenum, and the inferior vena cava may complicate surgical repair •Clinical signs: Similar to AAA

what does an inflammatory aneurysm look like on us? what does it esemble?

•Sonographic appearance: Fibrotic areas, low level echoes surrounding aneurysm. Differential diagnosis (dx) of retroperitoneal fibrosis, AAA with anterior wall clot, horseshoe kidney' Retroperitoneal Fibrosis can look like an Inflammatory Aneurysm. They are differential diagnoses for each other

this is a ___ that looks like a \_\_\_\_

A horseshoe kidney can look like an Inflammatory Aneurysm –

what are the 5 types of branch vess aneurysms?

Splenic Artery–Most common of all. Predominantly in females LUQ Pain, N/V, or asymptomatic • Hepatic Artery -- Second most common of splanchnic (visceral) vessels aneurysm. Predominantly in males. Asymptomatic until large. Hepatic necrosis, fever, chills, death Superior Mesenteric Artery -- Rarest . Vague symptoms. Non specific abdominal pain, fever • Renal Artery –Low incidence. HTN. Hematuria. Flank pain. Possible mass Iliac Artery. High association with AAA. Extension. In association with. Isolated Iliac aneurysm. Rare • Usually bilateral when they occur. Asymptomatic – If large: Pt. may have GI, GU, Neurologic symptoms • GI symptoms: N/V, Obstructions symptoms, bloating, unable to have bowel movement • GU symptoms: back, flank pain, anuric, bladder pressure sensation • Neurologic: Numbness in leg(s), cold leg(s), pain in leg(s). Pain

what do branch vessel aneurysms look like in us?

Dilation of vessel with or without thrombus – Anechoic or partially anechoic structure – Doppler helpful to determine presence of flow – Cardiac pulsations

the sonographer must image the entire aorta in at least 2 planes. t/f

what are possible auses for AAA

certain congenital defects atherosclerosis

most patients experience symptoms before they are diagnosed w/ an AAA?

surgical repair is recommened for an AAA at what size?

4-5cm

when an AAA is found it is important for the sonographer to check for possible involvement of the iliac arteries and the \_\_\_\_\_

renal arteries

what can be found w/i an AAA usually along the anterior or anterolateral wall?

thrombus

exanguination is the process \_\_\_\_

one udergoes when they bleed to death

of the following pathologies which one would not be a likely clinical differential diagnosis for an AAA? abdominal wall ernia fibroid uterus peri-aortic lymph nodes retroperitoneal tumor

abdominal wall hernia

the majority of AVF's are acquired secondary to trauma, iatrogenic trauma is one of these forms of trauma. t/f

all of the following are related to aortic dissectione xcept... hpertension cystic medial necrosis marfan's syndrom abdominal aortic aneurysm

abdominal aortic aneurysm