chapter 14- non-cardiac blood vessel disorders Flashcards
the vascular system consists of what 3 highly specialized components
arterial, venous and lymphatic systems
what is the role of the arterial system
carries oxygenated blood to the tissues of the body after is leaves the heart
what it the venous system responsible for
transporting deoxygenated blood back to the heart and lungs
what is the lymphatic system responsible for
carrying excess fluid from the tissue spaces back to the bloodstream
what are the three layers of vessels
intima, medial, adventitia
what are the structural elements most common to arterial vessels
endothelium, basement membrane, elastic tissue, collagen, smooth muscle
what are the risk factors for atherosclerosis
same as for CV dz: advancing age, cigarette smoking, dyslipidemia, HBP, DM, family hx of premature atherosclerosis, evidence of inflammation
what are arterioles
small arteries which lead to capillaries
what is PAD
occlusive disease of the aorta, iliac arteries, and arteries of the LEs
PAD usually presents with gradual onset of _____
LE claudication
what is often found on physical exam with PAD
decreased pulses, atrophic changes of skin, decreased capillary refilling, loss if hair, discoloration of skin, vascular bruits
what is the most reliable clinical sign of presence of PAD
decrease in or absence of the posterior tibial pulse
what is the most accurate, quick and non-invasive way to dx PAD (test)
ABI
what is a normal ABI and what is indicative of obstructive disease and severe disease
> .91 is normal. 0.9 or less is obstructive disease. 0.4 ir less is severe
when is stress testing used for diagnosing PAD
when there are typical symptoms of claudication with normal resting ABI measurements. ABI is measured at one minute intervals for 5 monies after exercise
what are segmental limb pressures
BP cuffs applied at various levels based on the results of ABI testing and location of clinical symptoms of claudication.
what segmental limb pressure reading is considered significant
20mmHg or greater reduction or difference in pressure between the segments along the same leg, or when compared to the same level in the opposite leg
what is segmental volume plethysmography
used along with segmental limb pressures, to locate level of disease. using transducers to detect volume change
what are treatment modalities for PAD
lifestyle, medical and surgical interventions.
what are the main indications for utilizing angioplasty for PVD
persistent claudication that significantly reduces the ability to perform ADLs, pain at rest, tissue loss
what is PTA
percutaneous transluminal angioplasty
what is thromboangiitis (Buerger’s disease)
a vasculitis strongly linked to cigarette smoking.
what are the risk factors for developing AAA
age over 60, male sex, family hx, tobacco use, presence for other large vessel aneurysms, CAD, PAD.
what is the most important clinical factor affecting aneurysm growth
elevated BP
what is the major complication of AAA
rupture
when is elective repair of asymptomatic AAA indicated
for AAA of 5.5cm diameter or more, AAA that is rapidly expanding and AAA associated with PAD being re-vascularized.
is endovascular or open AAA repair associated with less short term morbidity and mortality? what is the down side?
endovascular, but it is more prone to re-intervention rates with ongoing risk of rupture
are thoracic aortic aneurysms more common in males or females
males
wha are the most common risk factor for thoracic aneurysms
HTN
when seen in younger individuals, thoracic aneurysm is most often associated with _____
Marfan syndrome, and to lesser degree connective disease such as Ehlers-Danlos.
there is strong association between thoracic aneurysms and ____
bicuspid aortic valve
when is surgery indicated for thoracic aneurysm
with accelerated growth >=10mm per year or with diameter 50-60mm for ascending aneurysm or 60-70 for descending aneurysm.
what is vasculitis
group of rare diseases with inflammation of the blood vessels
what is polyarteritis nodes (PAN)
medium vessel vasculitis affecting arteries that contain muscular walls. damage leads to aneurysmal formation.
what is Kawasaki syndrome
acute vasculitis of childhood
what is granulomatosis with polyangitis (GPA, Wegener’s grnaulomatosis)
vasculitis of the small and medium vessels. primarily affects lungs and kidneys
what is giant cell arteritis (temporal arteritis)
inflammatory changes in one of the branches of tha aorta, almost always age >50, higher in females, most notably targets carotid, subclavian and axillary arteries
what is Takayas’s arteritis
large vessel vasculitis, involves aortic arch and its main branches, also coronary and pulmonary vessels in half the cases. females under age 40.
PAD can cause occlusion of all of the following vessels EXCEPT:
- aorta
- vena cava
- iliac artery
- femoral-popliteal artery
- vena cava
which of the following statements regarding Wegener’s granulomatosis is/are. correct?
A. it is a vasculitis of the large vessels
B. the majority of affected individuals are adults.
C. it primarily affects the lung and kidneys
B and C are correct (it is a vasculitis of small and medium vessels)
what are the 4 basic categories of thoracic aneurysms
ascending thoracic aneurysms, aortic arch aneurysms, descending aortic aneurysms, thoracoabdominal aneurysms
what are the smallest blood vessels in the vascular system
capillaries
