Peripheral Dz Notecards Flashcards
Types of Aortic Aneurysms:
- arterial
- abdominal aorta: 4-8% in elderly males
- abdominal thoracic: much less common
Types of Arterial Aneurysms:
- cerebral “berry” aneurysms: risk of rupture and SAH
- aortic: risk of rupture and hemorrhage; risk of arterial branch stenosis or occlusion
- peripheral(popliteal/carotid/femoral): emboli/thrombi
Risk of aortic rupture:
- increases a lot after 5cm: 5%/yr
- below 5cm: 1%/yr
AA growth:
1-4 mm/year
Pathopneumonic signs for Marfinoid syndrome:
steinburg and walker murdoch
AA dx:
1- duplex ultrasonography: ID suspect iliac and abdominal aneurysms
2- contrasted CT angiography: to ID branches of iliac arteries
3- MRA- but takes longer
AA clinical sxs:
- not ruptured: asymptomatic
- ruptured: severe hypotension and abdominal pain
- abdominal mass below umbilicus
- iliac aneurysm: hydronephrosis ipsilaterally via compressed ureter
- mural walll thrombis–> emboli in LE
- compress adjacent structures–> abdominal discomfort
Management of AAA rupture:
CV emergency: rq. prompt IV fluids w/ blood, isotonic saline and emergent surgery
AA Risk Factors:
- Atherosclerosis
- Hypertension
- Family history
- Smoking
- Cystic Medial Necrosis (Connective Tissue Disorders of Large Arteries)
- Marfan Syndrome
- Ehlers Danlos Syndrome aka “Rubber Man Syndrome”
- -Rare
- Vasculitis
- Takayasu Arteritis
- Giant Cell Arteritis (i.e. Temporal Arteritis)
- Chronic infection–>Syphilitic Aortitis
- Trauma
Clinical features include of Marfan’s: (7)
- Arachnodactyly (long fingers)
- Subluxation (dislocation) of lens in eye (Ectopia lentis)
- Long slender limbs
- Hx of spontaneous pneumothorax
- Murmurs (Mitral Valve prolapse/Aortic regurgitation)
- AA/Dissection
- degradation of CT of arteries
Marfan’s progression:
Spectrum of clinic severity from isolated features–> rapidly progressive multi-organ dz
Autosomal dominant disorder of CT
Marfan’s Syndrome
Tx of AAA:
- no surgical benefit 4-5.5 cm
- surgical tx: sxs of expansion, occlusion/compression, rupture, rapid expansion >1cm/yr, AAA>5.5cm
Screening for AAA:
one time screening abdominal US for males between 65-75 y.o. who: smoked > 5 packs of cigarettes in their life or with fam hx of AAA
Tx for a AAA >5.5:
Surgical option:
- OPEN (gortex graft within the aneurysm)
- Percutaneous ENDOVASCULAR ANEURYSM REPAIR (EVAR)
Tx for a AAA <5.5:
- Smoking cessation
- Tight BP control
- Beta-blockers helpful in Marfanoid
- CHOL reduction (STATINS)
- Monitoring aneurysm q6-12 months by duplex ultrasound
Acute Aortic Syndromes:
- Aortic Dissection: dissection of blood into the intimal layer resulting in a false lumen parallel to true lumen
- Incomplete Dissection: Tear without dissecting blood
- Intramural hematoma: Due to Vasa vasorum rupture–> hemorrhage in wall of Aorta
- Penetrating Ulcer: Ulceration of plaque penetrating intima
Aortic Dissection Risk Factors:
- Hypertension
- Connective Tissue Diseases (Marfan Syndrome, Ehlers Danlos Syndrome)
- Trauma
- Cocaine use
- Weight lifting
- Prior CABG/Bicuspid Aortic valve
- Preexisting AA
- Aortic Coarctation = narrowing of the aortic arch
- Vasculitides: Takayasu Arteritis or Giant Cell Arteritis
Classification of Aortic Dissection:
Stanford A (ascending/proximal)- 70-75% or Stanford B (descending/distal)- 25-30%
Aortic dissection’s and mortality:
- 1-2% mortality risk/hr during first 24-48 hrs
- Untx Aortic Dissections w/ increasing mortality in real-time:
25% risk of death in first 24hrs
50%: in first 48 hours
75%: in first week
90%: in first month
Clinical Presentation of Aortic Dissection:
- Sudden onset of anterior CP (‘tearing’ quality) and/or back pain (between scapulae)
- Chest pain more common in Type A and back pain and abdominal pain more common in Type B
- Painless dissection is RARE
- Also, Abdominal pain, syncope, and stroke
If dissection involves ascending aorta it can dissect against Coronary Arteries and cause:
MI
If dissection is distal:
it can cause ischemia to lower extremities and result in an ischemic neuropathy
Clinical Presentation of Aortic Dissection:
- Pulse deficits (weak or absent carotid, brachial or femoral pulses)
- Dissection back toward heart can cause Aortic regurgitation diastolic murmur
- CHF