FINALS: Peripheral Vascular Disease

Question 1

What defines Peripheral Vascular Disorders?

Answer 1

Any vessel distal to the coronary arteries, with vasculature below the aortoiliac bifurcation being most vulnerable to disease.

Question 2

What is Acute Arterial Injury, and what are common causes?

Answer 2

Acute arterial injury is usually due to trauma, such as Volkmann’s ischemia or radial artery compression from a humeral fracture.

Question 2

How is Acute Arterial Injury managed?

Answer 2

Management involves surgical repair.

Question 2

How does a false aneurysm form?

Answer 2

Due to damage to an artery, blood leaks until external pressure equals the arterial pressure, forming a hematoma that organizes and creates a central cavity lined with endothelium.

Question 2

Where is Arterial Thrombosis and Embolism most common?

Answer 2

It is most common at the femoropopliteal bifurcation.

Question 2

What is the most common source of emboli in Arterial Thrombosis and Embolism?

Answer 2

The heart is the most common source of emboli.

Question 3

What are the management options for Arterial Thrombosis and Embolism?

Answer 3

Anticoagulation and embolectomy

Question 3

What are the manifestations of Arterial Thrombosis and Embolism?

Answer 3

Decreased sensation → edema → ischemic muscle pain → skin demarcation → necrosis. 40 mmHg pressure is significant for gangrene formation.

Question 3

How is Thromboangiitis Obliterans managed?

Answer 3

Cessation of smoking, symptomatic treatment, and in severe cases, amputation.

Question 3

What population is most affected by Thromboangiitis Obliterans (Buerger’s Disease)?

Answer 3

Young males who are heavy smokers.

Question 3

What are the key manifestations of Thromboangiitis Obliterans?

Answer 3

Coldness, numbness, paresthesias, absence of pulse, and paralysis. Intermittent claudication occurs if collaterals are present.

Question 3

What arteries are involved in Thromboangiitis Obliterans?

Answer 3

Small and distal arteries, progressing proximally.

Question 3

What is Arteriosclerosis / Atherosclerosis Obliterans?

Answer 3

A chronic, progressive plaque buildup in large arteries, often in the middle third of the femoral artery and aortoiliac areas.

Question 3

What conditions are associated with Arteriosclerosis / Atherosclerosis Obliterans?

Answer 3

Diabetes and atherosclerosis.

Question 3

What are the manifestations of Arteriosclerosis / Atherosclerosis Obliterans?

Answer 3

Intermittent claudication, pain at rest, and gangrene.

Question 3

What are the manifestations of Raynaud’s Disease?

Answer 3

Digital cyanosis followed by redness and reflex vasodilation, causing pain and paresthesias in the hands. It may lead to trophic or superficial tissue necrosis.

Question 3

An idiopathic, intermittent, bilateral vasospasm of digital arterioles, usually occurring in women and aggravated by cold and stress.

Answer 3

Raynaud’s Disease

Question 3

What is Vibratory White Finger Syndrome, and what causes it?

Answer 3

An occupational disease similar to Raynaud’s, caused by the use of vibratory equipment. It involves progressive vasospasm of one or more fingers, potentially leading to amputation.

Question 3

What is an aneurysm?

Answer 3

A localized swelling of a pulsating vessel. It can be classified as a false, true, or dissecting aneurysm.

Question 3

What is a true aneurysm, and what causes it?

Answer 3

A result of vascular disease, often due to arteriosclerosis, causing the arterial wall to weaken and dilate, leading to thinning of the arterial coats. Commonly affects the aorta and popliteal arteries.

Question 3

What is superficial thrombophlebitis?

Answer 3

An embolic occlusion of a surface vein causing inflammation without significant edema.

Question 3

A condition involving significant edema that is often silent until a thrombus causes embolism, with the potential for life-threatening complications.

Answer 3

Deep Vein Thrombosis (DVT),

Question 3

What characterizes a dissecting aneurysm?

Answer 3

A tear in the tunica intima that leads to decreased blood pressure and cerebral blood flow, forming a pulsating mass that can cause symptoms like stasis, edema, thrombosis, and possibly fatal rupture.

Question 3

What is Phlegmasia Alba Dolens?

Answer 3

A massive iliofemoral venous thrombosis with arterial spasm, causing the leg to become pale, cool, and painful, with poor or absent distal pulses.

Question 4

How is Phlegmasia Alba Dolens differentiated from acute arterial occlusion?

Answer 4

: The presence of swelling, petechiae, and distended superficial veins helps differentiate it from acute arterial occlusion.

Question 4

What are the characteristics of Phlegmasia Cerulea Dolens?

Answer 4

Marked leg edema, cyanosis, and pain due to massive iliofemoral venous obstruction, often with petechiae present.

Question 4

What are Stasis Ulcers and what causes them?

Answer 4

Stasis ulcers result from occlusion of superficial veins, often due to prolonged standing in individuals with venous valvular insufficiency.

Question 4

What is Phlegmasia Cerulea Dolens?

Answer 4

An ischemic form of venous occlusion causing the leg to be painful, cyanotic, and edematous, with possible venous gangrene.

Question 4

What are Varicose Veins, and what are their types?

Answer 4

hickened, tortuous veins caused by chronic valvular insufficiency, aggravated by obesity and often familial.

Primary: Bilateral, due to inherited structural weakness of venous walls.
Secondary: Due to obstruction distal to the veins, caused by conditions like AV fistula or venous angiomata.

Question 4

What causes Chronic Lymphedema, and what are its manifestations?

Answer 4

An imbalance between lymphatic drainage and filtration, leading to protein-rich interstitial fluid accumulation, painless edema, and progression to sclerosis and elephantiasis.

Question 4

What are the manifestations of Stasis Ulcers?

Answer 4

Venous pooling leads to edema, skin discoloration near the medial malleolus, ulceration, and cellulitis in the foot and leg.

Question 4

What are the characteristics of Traumatic Lymphatic Pathological Conditions?

Answer 4

Usually present with swelling but have a good prognosis for recovery.

Question 4

What are Spider Veins/Telangiectasias?

Answer 4

The smallest varicosities, usually medically insignificant and of cosmetic concern. Common on the thigh, calf, and ankle. Managed with sclerotherapy.

Question 4

An acute, local inflammation spreading along lymph vessels from an area of cellulitis, causing infection, cellulitis, necrosis, and potentially persistent swelling and inflammation.

Answer 4

Lymphangitis

Question 4

What is the difference between Primary and Secondary Lymphedema?

Answer 4

Primary (Idiopathic/Hereditary): Congenital, familial, or conditions like Milroy’s disease. Lymphedema praecox occurs in the 2nd-3rd decades, while Idiopathic Lymphedema Tarde occurs after 35.
Secondary: Caused by obstruction or destruction of lymph vessels due to malignancy, or inflammatory conditions like recurrent lymphangitis.

Question 4

What are common symptoms of Pulmonary Embolism, a complication of DVT?

Answer 4

Coughing, dyspnea, and chest pain. The gold standard for diagnosing DVT is a venogram.

Question 5

How can lymphedema be differentiated from other conditions?

Answer 5

Lymphedema typically presents with generalized, non-red, painless swelling. Differential diagnosis involves examining similarities in swelling and redness and may require specific lab tests for confirmation.