Miscellaneous Conditions/ Testing Flashcards
Pseudo (false) aneurysm
A defect or hole in the arterial wall typically from trauma and iatrogenic (hospital acquired)
False because it does not involve all three layers
Most common site of pseudo aneurysm
CFA
How is pseudo aneurysm diagnosed
Identification of the sac with active blood flow. Flow into and out of this sac (a to and from flow pattern) is the hallmark of a pseudo aneurysm
Arteriovenous fistula (AVF)
Abnormal connection between the high pressure arterial system and low pressure venous system.
Congenital or traumatic
Thoracic Outlet Syndrome (TOS)
Compression of nerves, arteries, or veins
The result of an extra first rib (cervical rib) an old fracture of the clavicle (collarbone), or over developed muscle.
Common among athletes using repetitive motions of the arm and shoulder
What are the main types of TOS
Neurogenic - MOST COMMON (95% of all cases) present with pain and weakness
Venous - reduced venous outflow: swelling, pain, and possibly a bluish discoloration of the arm
Arterial - reduced arterial blood flow: pain, coldness, and paleness of the arm
Popliteal Artery Entrapment Syndrome (PAES)
Symptomatic compression or occlusion of the popliteal artery due to a developmentally abnormal relationship with the medial head of gastrocnemius (MHG) or less commonly with popliteus muscle or fibrous bands.
Dorsiflexion (gastrocnemius muscle contraction) results in compression of the popliteal artery.
common in young athletic persons (=60% are <30 years old), with male to female ratio of 15:1
Arteritis: Buerger’s Disease
affects small vessels in the upper and lower extremities
inflammation may lead to vessel thrombosis
occurs primarily in men <40 years old, heavy tobacco abuse
presents with hand or foot ischemia, rest pain and/or ulceration
Arteritis: Takayasu’s Arteritis
intimal fibrosis and vascular narrowing
MOST COMMONLY affecting large arteries usually the aorta and its main branches
often young or middle aged women of Asian descent
referred to as “pulseless disease” as patient often present with weak or absent pulses in the upper extremities on physical exams (arms, hands and wrists)
Arteritis: Temporal Arteritis
inflammation of the arterial wall of the superficial temporal artery or its branches
lack of proper diagnosis and treatment may lead to blindness
often described as an anechoic or hpoechoic “halo” surround the vessel
a biopsy is considered the definitive diagnostic “gold standard”
Raynaud’s phenomenon (Disease/Syndrome)
arterial spasm results in decreased blood flow, typically affecting the fingers, and less commonly toes, incidence = 4% of people have Raynaud’s
symptoms include: pallar, rubor, and/or cyanosis skin discoloration of the affected part, often numbness or pain
primary raynaud’s
MOST COMMON, vasospasm only, unknown etiology
secondary raynaud’s
vasospasm with the presence of a secondary cause (connection tissue disorder, fixed obstruction, smoking) and tissue necrosis, ulceration, gangrene
penile brachial index, what is considered normal and abnormal
normal >0.75
marginal 0.65-0.74
abnormal < 0.65
what types of arterial pathology can trauma cause
may result in intimal tear/dissection or transection of the vessel
compartment syndrome
groups of organs or muscles are organized into areas called compartments divided by strong connective tissue called fascia
most compartment syndromes are the result of injury are therefore acute and possibly a medical emergency
transcutaneous oximetry (TcPO2)
assess wound healing and determination of amputation level
PO2 <30mm/Hg - poor healing potential - wound unlikely to heal
hydrophone
used in the development of ultrasound equipment to include testing of power and intensity levels generated by the ultrasound beam as it passes through the medium
allen’s test
method to assess the potency of the palmar arch
radial and ulnar arteries are manually compressed, ulnar is released, and the hand observed for refilling
what is considered normal and abnormal in a Allen’s test
normal - color should return in <10seconds
abnormal - hand remains blanched
what is the purpose of pre operative arterial mapping
to determine the potency, size, and suitability of a vessel for use as a surgical bypass
to determine the suitability of the upper extremity arterial system for dialysis access AV fistula creation
what is radial artery mapping
determine suitability for use as a graft for peripheral/coronary artery bypass-creation of dialysis access fistula
assess the potency of the palmar arch using a modified Allen’s test
if abnormal do NOT proceed as the harvest of the radial artery will compromise hand blood flow
observe for abnormalities
measure the diameter o artery in prox, mid, distal, these should be >2mm
upper extremity arteries mapping
used for: creation of dialysis access AV fistula
measurement: anatomic variants, high/low brachial bifurcation, presence of disease
what is epigastric artery mapping
identify adequate arterial supplied muscle section for autogenous breast reconstruction (transverse rectus abdomens muscle [TRAM])
measurement: identify best-arterialized muscle segment
what is internal mammary artery (internal thoracic artery)
determines a normal or adequate vessel for: used as a recipient site for free flaps in breast reconstruction
use as a graft to the left anterior descending artery (LAD) in coronary bypass grafting
