Peripheral Vasculature in Health and Disease 1, Arterial Aspects

Question 1

What are the relative sizes of artery diameter?

Answer 1

Large vessels- aorta, great vessels in chest, iliac
Medium- mesenteric, renal, femoral, popliteal, tibial, subclavian, brachial, radial
Small- blood vessels in the hand and foot, the kidneys, the brain, the eye

Question 2

How does blood reach the peripheries by several routes?

Answer 2

Arteries have many anastomoses
Blood can reach target organs by several routes
Collateral circulation can compensate for occlusion of the main system in some circumstances

Question 3

Describe the starling forces across the capillary bed

Answer 3

Blood pressure (35 mmHg)
Osmotic (25 mmHg)
-Arteriole-
Blood pressure (16 mmHg)
Osmotic (25 mmHg)
-Venule-

Question 4

What is the arterial pathology when dilated?

Answer 4

Aneurysm

Question 5

What is the arterial pathology when narrowed?

Answer 5

Stenosis

Question 6

What is the arterial pathology when blocked?

Answer 6

Occluded

Question 7

What is the arterial pathology when split?

Answer 7

Dissection

Question 8

What is the arterial pathology when over sensitive?

Answer 8

Vasospasm

Question 9

What is the arterial pathology when inflamed?

Answer 9

Vasculitis

Question 10

Describe aneurysms

Answer 10

Definition= 1.5 x the normal diameter
Degenerative aneurysms most common
Inflammatory, mycotic (infective), traumatic can also occur
Connective tissue disease- Marfans, Loeys-Dietz

Question 11

How can aneurysms be detected?

Answer 11

CT Angiogram imaging

Question 12

How can aneurysms be repaired?

Answer 12

Open surgery

Endovascular repair

Question 13

Describe stenosis

Answer 13

Atherosclerosis
20% of UK population aged 55-75 have peripheral arterial disease
5% have symptoms
Cardiovascular risk HIGH

Question 14

Describe atherosclerosis

Answer 14

Lipid deposits
Cholesterol rich plaque
Calcification
Plaque rupture= occlusion

Question 15

What are the symptoms of stenosis

Answer 15

Claudication
Short distance Claudication
Nocturnal pain/ rest pain

Question 16

What is Claudication?

Answer 16

Pain on walking a fixed distance
Worse uphill
Eases rapidly when you stop
Angina of the leg

Question 17

What is the treatment for claudication?

Answer 17

Stop smoking
Aspirin
Lipitor tablets

Question 18

What are the symptoms of acute occlusion?

Answer 18

The 6 P’s

• Pain (sudden onset)
• Pallor
• Perishing cold
• Paraesthesia
• Pulselessness
• Paralysis

Question 19

What are the symptoms of chronic occlusion?

Answer 19

• Short distance claudication
• Nocturnal pain
• Pain at rest
• Numbness
• Tissue necrosis
• Gangrene

Question 20

What is the treatment for occlusion?

Answer 20

Stent

Amputation

Question 21

Describe amputation

Answer 21

• Median survival after amputation is 2.25 years
• 30 day mortality of 17%
• 30% lose the other leg with 2 years
• 6000 per year in UK

Question 22

Describe vasospasm

Answer 22

• Over active vasoconstriction
• Capillary beds shut down
• Triggers- cold, stress
• Can have underlying connective tissue disease

Question 23

Describe vasculitis of large vessels

Answer 23

Takayasu’s disease- “pulseless disease”

Question 24

Describe vasculitis of medium vessels

Answer 24

Giant Cell Arteritis/ Polymyalgia

Question 25

Describe vasculitis of small vessels

Answer 25

Lots of polyangiitis conditions usually involving the kidneys

Question 26

What is the treatment for vasculitis?

Answer 26

Steroids | Other immunosuppressive agents

Question 27

How are broken arteries caused?

Answer 27

Trauma Self-inflicted Iatrogenic ( illness caused by medical examination or treatment)

Question 28

What does IV Drug abuse cause?

Answer 28

Arterial pseudoaneurysm collection of blood that forms between the two outer layers of an artery, the tunica media and the tunica adventitia. It is usually caused by a penetrating injury to the vessel, which then bleeds, but forms a space between the above two layers, rather than exiting the vessel.

Question 29

Describe the link between Diabetes and Arterial disease

Answer 29

- Major problem for healthcare systems worldwide - Increasing incidence - Diabetic patients are 20 times more likely to have an amputation

Question 30

Describe Diabetic Foot

Answer 30

-Neuropathic (disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness) -Ischaemic -Infected -Calcified vessels -Small vessel arterial disease Patients can't see their feet (retinopathy)

Question 31

Describe Charcot Foot

Answer 31

- End-stage diabetic foot changes - Neuropathic - Warm (greater than 2 degrees than normal, AV shunting) - Multiple fractures - "Rocker bottom" sole (midfoot collapse)