VASC - Arterial disease & aneurysms

Question 1

(3) types of Atherosclerosis –athero-thrombosis

Answer 1

• Degenerative
• Generalised
• Segmental

Question 2

causes of an arterial occlusion

Answer 2

Atherosclerosis –athero-thrombosis

• Embolism (Cardiac, Arterial to arterial)
• Pro-coagulant state
• Low flow state
• Thrombosed aneurysm
• Dissection
• Fibro-muscular hyperplasia
• Arteritis
• Entrapment
• Advential cysts

Question 3

Define Claudication pain

Answer 3

Calf pain on exertion (+/- thigh, +/- buttock)
•Onset and severity related to workload
•Relieved with rest
•Reproducible

Question 4

Define Ischaemic rest pain

Answer 4

• Should only be in the most distal part of the limb
• Implies that perfusion is so poor that anaerobic metabolism is present in skin and nerves of extremity
• Matters whether foot perfusion is aided by gravity
• Patients awake with burning pain in extremity
• Often sit up and hang feet over edge of bed for relief
• In worse case, spend all night sleeping in a chair

Question 5

3 types/consequences of Critical limb ischaemia (CLI)

Answer 5

• Ischaemic rest pain
• Ulcers
• Gangrene

Measure ankle pressure & toe pressure.

Question 6

(3) Patterns of lower limb occlusive disease

Answer 6

• Aorto-iliac (inflow)
• Femoro-popliteal (outflow)
• Tibial / crural

Question 7

Claudication interventions

Answer 7

Angioplasty +/- stenting
•best for short segments
•better in proximal arteries

Endarterectomy
•short segments

Bypass
•longer blocks

Question 8

Describe Sudden / severe ischaemia pain

Answer 8

(usually an embolus)
•sudden onset
•pain
•altered feeling
•pale / mottled extremity
•coolness
•pain on using muscles or paralysis of muscles (especially weakness of anterior compartment muscles)
•pulseless

Later pain in extremity lessens as nerve function ceases due to ischaemia

Question 9

Pathology of aneurysm

Answer 9

• Destruction of elastin
• Eventual failure of collagen
• Local inflammation (matric proteins, metallo-proteinases)

Rupture is uncommon less than 5cm

Question 10

Rx aneurysm

Answer 10

Primary prevention
•Cigarette smoking embargo
•Control of hypertension?

Secondary prevention for rupture
•Screening and treatment of those aneurysms > 5 – 5.5 cm