Limb Vasculature Flashcards
Where is the subclavian artery in the thoracic outlet?
Posterior to anterior scalene muscle
Where is the subclavianvein in the thoracic outlet?
Anterior to the anterior scalene muscle
What is A?
Thoracoacromial artery
What is B?
Anterior circumflex humeral artery
What is C?
Posterior circumflex humeral artery
What is D?
Superior thoracic artery
What is E?
Lateral thoracic artery
What is F?
Subscapular artery
Where does the brachial artery begin?
The inferior border of teres major, anterior to triceps and brachialis
What is the main blood supply to the superficial palmar arch?
Ulnar artery
What is the main blood supply to the deep palmar arch?
Radial artery
What is the clinical presentation of thoracic outlet syndrome?
Upper extremity pallor, paresthesia, weakness, muscle atrophy, and pain
What are the most common compression sites in thoracic outlet syndrome?
Interscalene triangle (most common), also in subcoracoid space
What mechanisms can cause thoracic outlet syndrome?
trauma, hemorrhage/hematoma/displaced fracture, repetitive motions (via swelling and compression), repetitive arm/shoulder motion, anatomic variations, tumors/large lymph nodes, injury to back/neck, poor posture
What demographics are most susceptible to neurogenic thoracic outlet syndrome?
Teens-60 year olds, female sex predominance
What are symptoms of neurogenic thoracic outlet syndrome?
upper extremity paresthesia, neck pain, trapezius pain, chest pain, occipital headache
What demographics are most susceptible to venous thoracic outlet syndrome?
Male sex predominance, aged 15-45, physically active
Where does subclavian vein compression commonly occur in venous thoracic outlet syndrome?
Costoclavicular space
What demographics are most susceptible to arterial thoracic outlet syndrome?
It is the most rare, no sex predominance, mostly young adults
What is the upper extremity presentation in venous thoracic outlet syndrome?
Swelling, cyanosis, heaviness, pain
What conditions are associated with venous thoracic outlet syndrome?
Raynaud’s-like symptoms, pulmonary embolism from DVT
Where is the subclavian artery compressed in arterial thoracic outlet syndrome?
Within the costoclavicular space, possibly by an anomalous first rib, or at the level of the pectoralis minor tendon/humeral head in athletes
What tests are used to evaluate for thoracic outlet syndrome?
Plain radiographs, MRI, CT, venous doppler, angiogram, EMG
What is the treatment for thoracic outlet syndrome?
Conservative treatment with PT, postural changes, and surgery if there are neurologic changes or vascular changes that lead to ischemia
What is the roos test?
Have patient lift up arms at a 90 degree angle and open/close fists for two minutes. Report any pain/fatigue/numbness/tingling. It is sensitive, but not specific, for thoracic outlet syndrome
What are perforating veins?
Veins that penetrate the deep fascia and drain into the deep venous system that have valves for unidirectional blood flow
What is the clinical presentation of DVT?
Throbbing pain, leg swelling/edema, redness/erythema, increased warmth, pain while walking or bearing weight
What are risk factors for DVT?
Surgery with anesthetic, hospitalization, C-section, estrogen therapy, pregnancy/postpartum, leg injury with reduced mobility for > 3 days, active cancer, IBD, SLE
What is the treatment for a DVT?
anticoagulation
What are acute and chronic complications of a DVT?
Acute: pulmonary embolism (fatal or non-fatal)
Chronic: post-thrombotic syndrome, venous ulceration
What is a popliteal cyst?
A fluid-filled distention of a preexisting bursa in the medial popliteal fossa
What is the clinical presentation of a ruptured Baker’s cyst?
Can be asymptomatic, can cause leg edema or bruising, can have knee pain
What is the best way to visualize a Baker’s cyst?
MRI (best) or ultrasound/venous doppler
What is the treatment for a ruptured Baker’s cyst?
Treat with analgesics for pain, sometimes glucocorticoid injections. Edema resolves on its own.
What borders the popliteal fossa?
Biceps femoris superolaterally
Semimembranosus muscle and semitendinosus superomedially
Medial and lateral heads of gastrocnemius inferomedially and laterally
What is the clinical presentation of popliteal artery entrapment?
Claudication pain, uncommon for pain at rest
What are the causes of popliteal artery entrapment?
Anatomic anomalies or muscle hypertrophy in the setting of normal anatomy
What tests are used to evaluate popliteal artery entrapment?
Ankle-brachial index (ratio of ankle BP to arm BP), ultrasound with doppler, MRI, angiography
What is the treatment for popliteal artery entrapment?
Surgery if symptoms persist
What is atherosclerosis?
A disease where plaque made of fat/cholesterol/calcium/etc builds up in your arteries, hardens, and narrows arteries limiting blood flow
What are symptoms of peripheral artery disease?
Muscle pain with exertion, feeling of ache/cramp/numbness/fatigue, pain resolves with rest even standing
What is the most sensitive extremity finding of peripheral artery disease?
Lack of palpable pulses
What is the treatment for peripheral artery disease?
Modify risk factors, exercise
What chronic disease state is SLE one of the strongest risk factors for?
Cardiovascular disease
Which of the following signs symptoms are typically associated with venous thoracic outlet syndrome?
a) neurologic changes
b) swelling
c) paresthesias
d) increased warmth
b) swelling
A ruptured popliteal cyst is associated with which of the following?
a) ischemic changes in limb
b) abnormal ankle-brachial index
c) calf pain
d) diminshed dorsalis pedis pulse
c) calf pain
