M7: Peripheral Arterial Disease Part 2 Flashcards
describe a false aneurysm
common cause
pulsating hematoma that originates from a leaking artery and is confined by surrounding tissue, not by an aterial wall
arterial punture (most common), trauma, infection
what must be seen to diagnose a false aneurysm
neck, or communicating channel b/w the main artery and pulsating mass
Us appearance of pseudoaneurysm
- swirling of colour in the ‘hematoma’, doppler will have low velocity turbulent flow
- communicating tract w/ a high velocity spectral tracing and spectral broadening w/ to and fro flow
does diastolic flow get through the neck of a false aneurysm
no, only systolic flow
treatment for pseudoaneurysm… describe them
- US guided compression… compress for 10 mins to close off the neck, rest, compress again for 10 mins… may take up to 1 hour
- thrombin injection into the pseudoaneurysm
risks for US guided compression for a pseudoaneurysm
what happens if treatment isn’t successful
arterial occlusion and venous thrombosis
patient will likely need surgery
describe arteritis
which arteries are affected
inflammation of the arterial wall
tibial arteries and distal arterioles
types of arteritis
takayasu’s
temporal
polyarteritis
buerger’s disease
most common type of arteritis
who’s most affected
buerger’s disease
men < 40 who are heavy smokers
describe coarctation of the AO
congenital narrowing of the thoracic AO that may also affect abdo AO and lead to lower extremity ischemia
describe raynaud’s phenomenon
cause
a vasospastic disorder/cold sensitivity characterized by intermittent ischemia in the fingers or toes due to cold exposure or emotional stress
unknown, can be a result of underlying disease
use of US w/ suspected raynaud’s phenomenon
R/O obstructive disease or emboli in the larger vessels
which type of testing is most appropriate than US to assess for raynaud’s phenomenon
indirect testing
2 types of raynaud’s phenomenon
Primary Raynaud’s disease
secondary Raynaud’s disease
describe Primary Raynaud’s disease
who does it typically affect
prognosis
intermittent digital ischemia cause by arterial spasm when exposed to cold temp… digits go pale, cyanotic, then red as they warm up, always bilateral
women
good, doesnt progress
another name for Primary Raynaud’s disease
underlying cause
spastic Raynaud’s syndrome
idiopathic
describe secondary Raynaud’s disease
same symptoms are primary but rxn to cold exposure is due to underlying obstructive systemic disease… chronic condition w/ ischemia constantly present
what can secondary Raynaud’s disease lead to
ulceration, gangrene, amputation
another name for secondary Raynaud’s disease
obstructive Raynaud’s disease
possible causes of secondary Raynaud’s disease
lupus, scleroderma, burger’s, frostbite
describe compression/entrapment syndromes
swelling of osteofascial compartments of the upper and lower extremities which causes pressure to increase I those compartments and compromise blood flow to the tissue
how do we assess for compression/entrapment syndromes
assess the arteries that lie w/in or next to the site of interest w/ doppler to see if blood flow is present or diminished
treatment for compression/entrapment syndromes
fasciotomy
describe popliteal entrapment
what can it lead to
compression of pop A by the gastrocnemius muscle…
this repeated trauma to the artery may lead to the development of an aneurysm, thrombosis, atherosclerosis and emboli
symptom of popliteal entrapment
who is commonly affected
pain w/ exercise (can be confused w/ claudication)
young adults and children
do patients w/ popliteal entrapment have norm pulses and waveforms at rest
when will that change
yes
any type of mild exertion
what patient movement and change indicates a popliteal entrapment
when patient points their foot downwards and theres a decrease in arterial diameter resulting in a visualized stenosis or loss of pulse.
is diagnosis of popliteal entrapment w/ duplex controversial
yes, some think the reduced arterial diameter when pointing the foot is normal…. could use CTA or MRA instead
what is adventitial cystic disease
focal stenosis or occlusion of the popliteal artery as well as seeing the lumen compressed by a cyst (often a bakers cyst)
describe thoracic outlet syndrome
what does it cause
compression of the subclavian artery/vein/nerves b/w the clavicle and first rib as they exit the thoracic outlet
hand and arm ischemia, pain and weakness w/ arm in certain positions (often above head)
what is a + US test for thoracic outlet syndrome
+ test shows decrease in flow velocities or occlusion of flow in the position of pain
describe an AV fistula
communication b/w an artery and adjacent vein that includes a colour bruit w/ a high velocity signal, and low resistance waveform…. can be congenital or traumatic
most common site of AV fistula
when else might you see it
CFA and CFV post catheterization
may be contracted for hemodialysis in the UE
what other type of vascular pathology often occurs w/ an AV fistula
pseudoaneurysm b/c of trauma
describe blue toe syndrome
treatment
toe ischemia due to micro-emboli traveling from a prox diseased artery and lodging in small arteries/arterioles
removal of emboli
describe extrinsic compression
what can it cause
artery is compressed from external structure
stenosis or occlusion by applying press on arterial walls and compromising blood flow
Another name for buergers Disease
Theomboangitis obliterans
