atherosclerosis and aneurysms Flashcards
______ 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))
________ 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.
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
what happens w/ atherosclerosis?
Loss of arterial compliance
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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
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Plaques
Both lead to decrease profusion of an organ/tissue
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.
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
what will u find sonographically w/ atherosclerosis
Thickening of intimal lining
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Intimal irregularities
Plaques
Shadowing
Non-shadowing
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Calcifications
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Tortuosity
which one is normal?
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.
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:
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
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
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Connected to vessels by a neck
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Saccular (true)
____ is 2 adjacent fusiform aneurysms
dumbell shaped aneurysm
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
what type of anuerysm?
what type of aneurysm
fusiform
what is this?
saccular aneurysm
what type of aneurysm involves all layers.
true
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.
what is this?
pseudoaneurysm
During systole blood flows into the PA. In diastole blood flows back into the supplying vessel.
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.
what do you see here?
aneurysm
what can you see here?
thrombosis
Which line is the correct plane and level to make an accurate measurement
the red is most accurate
describe the Post repair appearance of an aneurysm
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Often graft material is echogenic
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May be placed within native AO or to the side of native AO
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Thrombosis is often seen surrounding graft material
what are teh common types of grafts?
what might this be?
Aneurysm
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Post repair appearance
what has Separation of layers, intima and media, of the aortic wall
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Most commonly in the thoracic aorta (Why do you think)
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Mild to no dilation of the aorta
Aneurysm
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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.
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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
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Type 3: Involves descending AO and extends into abdominal AO, common, low mortality, good prognosis
what is this?
aortic dissection aneurysm
Intimal flap
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Thin, echogenic line inside AO
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Flap moves with blood flow
http
what do you see here?
what do you need to do w/ you 2d and color ?
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Intimal flap can be mistaken for AAA hematoma
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Use Color Doppler
Higher scale
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Lower gain
Gain setting
Too high
Too low
Reduce color artifact
describe teh sonographeic appearance of an aortic rupture
Hematoma associated with aneurysm located anywhere in the retroperitoneum.
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Echogenicity is variable
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Size is variable
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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
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