Laflamme- Chapter 8 (Peripheral Vascular Disease) Flashcards
What is the definition of an aneurysm?
- Diameter > 150% of normal for age/gender/BSA
What is the definition of a pseudo-aneurysm?
-Rupture of arterial wall contained by hematoma and adjacent tissues
What are 4 infectious causes of TAA?
- Syphilis
- HIV
- Salmonella
- Staphylococcus
Indication for TAA repair in degenerative dx?
- 5.5 cm
- more than 5mm/yr
- Compressive symptoms
Repair for TAA if going for AVR?
-4.5 cm
3 indications for Aortic repair in BAV?
- 5.5cm
- > 5 cm if family history of dissection
- > 5mm/ year
Aortic repair in patients with Marfans, Loeys Deitz and Turners?
- 5 cm
- 44mm or more
- > 25mm/m2
Definition of large mediastinum on AP CXR?
- > 8cm at the carina
Follow up by CTA for Dissection treated conservatively?
-1, 3, 6, 12, 18, 24 months
What are 3 indications to surgically repair type b dissection when initially managed conservatively?
> 55-60mm
> 4mm/year growth
Target organ ischemia or recurrent pain
Definition of AAA?
> 30 mm
6 RFs for AAA?
- Age
- Male
- Smoking
- COPD
- HTN
- Dyslipidemia
When to screen for AAA?
-Male aged 65-80 (updated)
Indications for AAA? (4)
> 55 mm
Symptoms
Progression > 10mm/yr
Infectious or inflammatory
Surveillance for AAA based on size?
30-39mm: q3 years
40-44mm: q2 years
> 45mm: q1 years
Name 4 genetic aortopathies and their genetic mutations
Marfan: FBN1 (AD)
LD: TGFBR1 (AD)
ED Type 4: COL3A1 (AD)
Turners 45XO
4 inflammatory causes of Aortopathy?
- Takayasu’s
- GCA
- Bechets
- Ank Spond
What is 5 year mortality for patients with PAD?
10-15%, equal risk to CAD
What is the Fontine classification for PAD?
- Asymptomatic
- Intermittent Claudication
- Rest pain
- Ulcer/Gangrene
Who should get an ABI? (4)
Suspected claudication
Poor wound healing
> 50 years + DM/Smoking
> 65 with intermediate FRS
What is subclavian steal syndrome?
Claudication of the arm, reversal of flow of the vertebral artery or of a mammay bypass grafts to perfuse the arm
BP difference of 10 mmhg
Why does Bilateral Renal Artery Stenosis result in flash pulmonary edema?
-Increased BP with salt and water retention in the absence of compensatory sodium excretion -> flash pulmonary edema
5 reasons to investigate for RAS?
Onset of HTN < 30 or > 55
Severe or refractory HTN
Underlying atherosclerosis
Increase Cr > 30% with ACE/ARB
Recurrent flash pulmonary edema
2 trials that support additional ECG monitoring beyond 24h for SCAF in TIA/Stroke?
- Embrace
- Crystal-AF
What is NNT for CEA in Symptomatic Carotid Artery Stenosis?
6
Two class 1 indications for CEA in Carotid artery Stenosis? 1 class II?
Symptomatic 70-99% (1a), 50-69% (Ib)
Asymptomatic >70% (2a)
Within 14 days
What is the pathology of HIT?
Antibodies directed against the neoantigens on proteins PF4 (Proteins released by activated platelets)
What should severity and timing of HIT be?
> 50% of platelets or thrombosis beginning 5-10 days after the start of heparin
What are the 4 components of the 4T score?
Thrombocytopenia (> 50% decrease in plt and keep > 20)
Timing (5-10 days post 1st exposure)
Thrombosis
Other causes (no other cause)
Definition of Type 1 PHT?
mPAP > 20 mmhg
Wedge < 15 mmhg
WU > 3
3 meds that cause PAH?
- Anorectics
- Fenfluramine
- Dexfenfluramine
5 systemic causes of PAH?
HIV
Collagen Diseases
Portal Htn
Congenital heart disease/shunt
Schistosomiasis
3 classes of etiologies for Group 5?
Hematological diseases, Systemic diseases, Systemic diseases
7 diagnostic work up for PHTn?
- CXR
- PFTs
- Immunologic testing
- CPAP
- Right and Left heart cath
- VQ scan
- High resolution CT
What is definition of positive vasoreactivity testing?
Absolute decrease of mPAP > 10mmhg (to mPAP < 40mmHg) in the absence of decreased CO
Three drugs that can be used in for vasoreactivity testing?
Inhaled NO
Epoprostenol
Adneosine
5 conservative managements for PH?
Rehabilitation
Avoid high altitude
Vaccination
Smoking cessation
Sodium restriction
Name 9 PAH therapies?
- Diuretics
- CCBs
- Prostanoids (Epoprostenol)
- Selexipag
- Endothelin Receptor Antagonist (Ambrisentan, Bosentan)
- PDE5 inhibitor: Sildenafil, Tadalafil
- Guanylase Cyclase stimulator: Riociguat
what are 3 histopathologic processes for aortic generation?
- Increase Metalloproteinases
- Decreased elastic fibers
- Increased proteoglycans
What % of Turner’s syndrome have BAV? Aortic Coa?
BAV: 20%
CoA: 10%
What are two criteria for critical limb ischemia?
-Ischemic pain at rest OR Ischemic lesion (ulcer, gangrene)
What is one year mortality for someone presenting with one year mortality?
25%
Name 5 mechanisms of stroke
- ICH
- SAH
- Large vessel disease
- Lacunar/Small vessel
- Cardioembolic
What is westermarks sign?
Segmental oligemia secondary to proximal artery occlusion
What is Hampton hump?
Triangular hyperdensity adherent to the pleura secondary to pulmonary infarction
When to go with Carotid Stenting instead of CEA?
-Focal lesion, Radiation therapy previous in area, high operative risk, obesity
What is the only PH therapy that has survival benefit?
-Epoprostenol
What are the main adverse effect of Endothelin antagonists?
-Liver injury
