M7: Peripheral Arterial Disease Part 2

Question 1

describe a false aneurysm

common cause

Answer 1

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

Question 2

what must be seen to diagnose a false aneurysm

Answer 2

neck, or communicating channel b/w the main artery and pulsating mass

Question 3

Us appearance of pseudoaneurysm

Answer 3

• 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

Question 4

does diastolic flow get through the neck of a false aneurysm

Answer 4

no, only systolic flow

Question 5

treatment for pseudoaneurysm… describe them

Answer 5

• 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

Question 6

risks for US guided compression for a pseudoaneurysm

what happens if treatment isn’t successful

Answer 6

arterial occlusion and venous thrombosis

patient will likely need surgery

Question 7

describe arteritis

which arteries are affected

Answer 7

inflammation of the arterial wall

tibial arteries and distal arterioles

Question 8

types of arteritis

Answer 8

takayasu’s
temporal
polyarteritis
buerger’s disease

Question 9

most common type of arteritis

who’s most affected

Answer 9

buerger’s disease

men < 40 who are heavy smokers

Question 10

describe coarctation of the AO

Answer 10

congenital narrowing of the thoracic AO that may also affect abdo AO and lead to lower extremity ischemia

Question 11

describe raynaud’s phenomenon

cause

Answer 11

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

Question 12

use of US w/ suspected raynaud’s phenomenon

Answer 12

R/O obstructive disease or emboli in the larger vessels

Question 13

which type of testing is most appropriate than US to assess for raynaud’s phenomenon

Answer 13

indirect testing

Question 14

2 types of raynaud’s phenomenon

Answer 14

Primary Raynaud’s disease

secondary Raynaud’s disease

Question 15

describe Primary Raynaud’s disease

who does it typically affect

prognosis

Answer 15

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

Question 16

another name for Primary Raynaud’s disease

underlying cause

Answer 16

spastic Raynaud’s syndrome

idiopathic

Question 17

describe secondary Raynaud’s disease

Answer 17

same symptoms are primary but rxn to cold exposure is due to underlying obstructive systemic disease… chronic condition w/ ischemia constantly present

Question 18

what can secondary Raynaud’s disease lead to

Answer 18

ulceration, gangrene, amputation

Question 19

another name for secondary Raynaud’s disease

Answer 19

obstructive Raynaud’s disease

Question 20

possible causes of secondary Raynaud’s disease

Answer 20

lupus, scleroderma, burger’s, frostbite

Question 21

describe compression/entrapment syndromes

Answer 21

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

Question 22

how do we assess for compression/entrapment syndromes

Answer 22

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

Question 23

treatment for compression/entrapment syndromes

Answer 23

fasciotomy

Question 24

describe popliteal entrapment

what can it lead to

Answer 24

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

Question 25

symptom of popliteal entrapment

who is commonly affected

Answer 25

pain w/ exercise (can be confused w/ claudication)

young adults and children

Question 26

do patients w/ popliteal entrapment have norm pulses and waveforms at rest

when will that change

Answer 26

yes

any type of mild exertion

Question 27

what patient movement and change indicates a popliteal entrapment

Answer 27

when patient points their foot downwards and theres a decrease in arterial diameter resulting in a visualized stenosis or loss of pulse.

Question 28

is diagnosis of popliteal entrapment w/ duplex controversial

Answer 28

yes, some think the reduced arterial diameter when pointing the foot is normal…. could use CTA or MRA instead

Question 29

what is adventitial cystic disease

Answer 29

focal stenosis or occlusion of the popliteal artery as well as seeing the lumen compressed by a cyst (often a bakers cyst)

Question 30

describe thoracic outlet syndrome

what does it cause

Answer 30

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)

Question 31

what is a + US test for thoracic outlet syndrome

Answer 31

+ test shows decrease in flow velocities or occlusion of flow in the position of pain

Question 32

describe an AV fistula

Answer 32

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

Question 33

most common site of AV fistula

when else might you see it

Answer 33

CFA and CFV post catheterization

may be contracted for hemodialysis in the UE

Question 34

what other type of vascular pathology often occurs w/ an AV fistula

Answer 34

pseudoaneurysm b/c of trauma

Question 35

describe blue toe syndrome

treatment

Answer 35

toe ischemia due to micro-emboli traveling from a prox diseased artery and lodging in small arteries/arterioles

removal of emboli

Question 36

describe extrinsic compression

what can it cause

Answer 36

artery is compressed from external structure

stenosis or occlusion by applying press on arterial walls and compromising blood flow

Question 37

Another name for buergers Disease

Answer 37

Theomboangitis obliterans