Pathophysiology of vascular disease

Question 1

What is an aneurysm?

Answer 1

localised abnormal dilation of a blood vessel or the heart

Question 2

What is a true aneurysm?

Answer 2

when an aneurysm involves an intact attenuated arterial wall or thinned ventricular wall of the heart
- atherosclerotic
- syphilitic
- congenital vascular aneurysms
- ventricular aneurysms that follow transmural MIs

Question 3

Name 3 types of true aneurysm

Answer 3

saccular
fusiform
dissecting

Question 4

What is an arterial dissection?

Answer 4

arises when blood enters the arterial wall itself, as a haematoma dissecting between its layers

Question 5

Describe the pathogenesis of a false aneurysm (pseudo-aneurysm)

Answer 5

defect in vascular wall leading to extravascular haematoma

freely communicated with the intravascular space (pulsating haematoma)

pulsating haematoma surrounded by thin fibrous capsule in communication with the lumen of a ruptured vessel

unlike a true aneurysm, it does not consist of the true layers of the arterial wall

Question 6

What is a saccular aneurysm?

Answer 6

spherical outpouchings
often contain a thrombus

Question 7

What is a fusiform aneurysm?

Answer 7

diffuse circumferential dilation of a long vascular segment

Question 8

List factors that predispose to weakening of the arterial wall

Answer 8

atherosclerosis
hypertension
trauma
vasculitis
congenital defects (eg. Berry aneurysms in circle of willis)
infections (mycotic aneurysms)

Question 9

Pathogenesis of AAA

Answer 9

associated with atherosclerosis
atherosclerotic plaque in the intima compresses the underlying media
compromises nutrient and waste diffusion from the vascular lumen into the arterial wall
media therefore undergoes degeneration and necrosis
arterial wall weakness and consequent thinning

Question 10

AAA risk factors

Answer 10

men
smoker
age 50+
atherosclerosis

Question 11

Consequences of AAA

Answer 11

rupture into peritoneal cavity or retroperitoneal tissues with potentially fatal haemorrhage

obstruction of branch vessel - ischaemic injury of downstream tissues

embolism from atheroma or mural thrombus

impingement on adjacent structures

Question 12

What situations can result in aortic dissection?

Answer 12

mean 40-60 with antecedent hypertension

younger patients with systemic/localised abnormalities of connective tissue affecting the aorta (eg. Marfan)

Iatrogenic

during/after pregnancy

Question 13

Aortic dissections treatment

Answer 13

sudden onset excruciating pain
beginning in anterior chest
moving downward as dissection progresses
radiating to back between scapulae

Question 14

Stanford type A aortic dissections

Answer 14

Involves the ascending aorta, arch of the aorta

Question 15

Stanford type B aortic dissections

Answer 15

Involves the descending aorta

Question 16

What is Buerger’s disease?

Answer 16

Thromboangiitis obliterans

Question 17

Describe presentation of Buerger’s disease

Answer 17

young males
severe ischaemia of extremities
addicted to cigarette smoking
migratory superficial phlebitis

cold sensitivity of Raynaud type in hands
pain in instep of foot
chronic ulcerations of feet, toes or finger

Question 18

Describe varicose veins

Answer 18

abnormally dilated, tortuous veins
produced by prolonged, increased intraluminal pressure and loss of vessel wall support
superficial veins of lower leg are typically involved

Question 19

Pathogenesis of varicose veins

Answer 19

varicose dilation renders venous valves incompetent

leads to stasis, congestion, edema, pain, and thrombosis

stasis dermatitis and ulcerations

poor wound healing and superimposed infections can lead to chronic varicose ulcers

embolism from superficial veins is rare