vascular Flashcards
what indentation will be seen on barium swallow with an abberant right subclavian artery ?
posterior indentation
what is the diverticulum of kommerel ?
small bulge at the origin of an aberrant subclavian artery (usually aberrant right subclavian artery with a left sided aortic arch)
what is the most common cause of an aortic dissection ?
high blood pressure
what does the false lumen usually look like on CT ?
the false lumen is usually larger with lower contrast density on arterial phase - it can also become thrombosed due to slower flowing blood
where does a Stanford B aortic dissection start ?
between the brachiocephalic trunk and left subclavian artery
what are the vasa vasorum ?
the small blood vessels that supple the walls of the large arteries
what are intramural haematomas caused by ?
rupture of the vasa vasorum
where do traumatic aortic injurys tend to occur ?
aortic rooth, isthmus and hiatus
what is aortic transection?
complete tear through all the layers of the aorta
what is the size criteria of a thoracic aortic aneurysm ?
ascending aorta > 4cm
Descending aorta >3.5cm
what is annuloaortic ectasia associated with ?
marfans, Ehlers-danlos, homocystinuria and osteogenesis imperfecta
when is surgical treatment recommended for a thoracic aortic aneurysm ?
> 5.5cm ascending
6cm descending TAA
which arteries does GCA tend to affect ?
upper extremity vessels
temporal artery
subclavian, brachial, axillary
what type of wall thickening does GCA tend to cause ?
long smooth stenosis with circumferential wall thickening
what are the most common infections causing infectious aortitis ?
s.aures
e.coli
salmonella
pneumococcus
syphillis
what is takayasu arteritis ?
large vessel vasculitis causing long smooths circumferential thickening and stenosis of the large vessels including the aorta, subclavicn, carotid, pulmonary and mesenteric arteries
what is shone syndrome
left sided obstructive congenital heart disease
1 - supravalvular mitral membrane
2. subvalvular aortic stenosis
3. parachute mitral valve
4. aortic coarctation
what is subclavian steal syndrome ?
proximal stenosis / occlusion of the subclavian artery
causing retrograde flow from the vertebral artery into the subclavian artery
how does subclavian steal syndrome present ?
syncope exacerbated by arm exercise.
what are the common causes of SVC obstruction
compression due to thoracic malignancy
catheter associated thrombosis
mediastinal fibrosis due to histoplasmosis exposure
what is the classic abdominal imaging finding of SVC obstruction ?
increased enhancement of hepatic segment 4a due to collateral opacification of the vein of sappey
where does a left sided SVC usually drain into ?
coronary sinus -> the right atrium
what is the size criteria for an abdominal aortic aneurysm ?
what size is treatment recommended
> 3cm
5.5 - surgical treatment
what is leriche syndrome ?
Complete occlusion of the distal abdominal aorta due to atherosclerosis
what is polyarteritis nodosa ?
systemic necrotizing vasculitis or small and medium sized arteries - causing multiple small visceral aneurysms with raised p-anca
which arteries does Polyarteritis nodosa commonly affect ?
hepatic, mesenteric and renal
which medical conditions is PAN associated with ?
CLASH
Cryoglobulinemia
leukaemia
Rheumatoid arteritis
srogens syndrome
hepatitis B
what is the treatment of splenic aneurysms ?
endovascualar coil embolisation
what is fibromuscular dysplasia ?
idiopathic, non-infectious, non-inflammatory vascular disease primary affecting the renal and carotid arteries
what is the classic imaging feature of fibromuscular dysplasia
string of beads sign caused by alternating stenosis and aneurysmal dilatation of the renal artery
what is the treatment of firbomuscular dysplasia
angioplasty
what’s the most common cause of renal artery stenosis in children
takayasu
in a GI bleed - what is the rate of bleeding that can be detected on a CTA ?
0.3-0.5 ml/min
what is may-thurner syndrome ?
chronic compression of the left common iliac vein by crossing right common iliac artery against the lumbar vertebrae
what is the most common site of stenosis of the SFA?
at the adductor hiatus
what’s the gold standard investigation for calf caldication?
DSA
what is thrombosisangitis obliterans ?
non-atheroscerlotic arteritis of the small vessels - usually hands and feet. that occurs in young male smokers.
Causes extensive occlusive disease
what criteria makes fixing an abdominal aorta with end-vascular repair Okay ?
> 10mm from the renal arteries
angle of the neck <60 or >120
Common iliac arteries >7mm diameter and >20mm long
what is neurogenic thoracic outlet syndrome ?
nerve compression of the brachial plexus
what is adsons manoeuvre ?
tests for aterial thoracic outlet syndrome
test the radial pulse, get the patient to move their head to the other side and then the pulse reduces
what is the most common cause of subclavian artery compression ?
cervical rib
what is mccleery syndrome ?
subclavian vein compression without thrombosis
what is paget-schroetter syndrome
thrombosis of the subclavian vein as it enters the thorax - occurs in young men
what is the classic feature of hypothenar hammer syndrome ?
CTA shows a corkscrew appearance of the ulnar artery -
what is the definition of an iliac artery aneurysm and when should it be treated ?
> 2.5cm and treated if > 3cm
what is burgers disease ?
chronic inflammatory thrombotic arteritis that affects the lower extremities - usually the feet/.
seen in young male smokers
what is the preferred treatment for an iliac artery ?
end-vascular stent-graft
what is a persistent sciatic artery?
where the fetal sciatic artery persists to supply the majority of the blood to the leg. it arises from the internal iliac artery
what is the Rutherford classification used for ?
categorizes chronic limb ischemia
what is the most common source of an acute thromboembolic disease ?
left atrial thrombus
what is popliteal entrapment syndrome
compression of the popliteal artery by a fibrous band or calf muscle
what is cystic adventitial disease ?
a cause of distal claudication where there are mucoid cysts in the adventitia of the popliteal artery - which leads to luminal compression
what is the normal peak systolic velocity in the large arteries ? (carotid )
60-100cm/sec
if the peak systolic velocity is >125cm/sec what does it suggest ?(carotid )
> 50% stenosis
if the peak systolic velocity is >230 cm/sec what does it suggest ?(carotid )
> 70 % stenosis
, what peak systolic velocity would indicate renal artery stenosis
> 180cm/sec
