vascular Flashcards
What is chronic arterial insufficiency
- Any condition that slows or stops the flow of blood through vessels
what is formed in angiogenesis / neoangiogenesis
collateral vessels
- Peripheral arterial disease more common in
men in elderly
order of blood flow
- Artery arteriole capillaries venule vein
layers of arteries
- Intima -> media -> adventitia (innermost to outermost layer of arteries)
anatomy of leg arteries
L4 = aorta goes into r and l external iliac arteries
femoral and then popliteal artery
splits into anterior and posterior tibial, peroneal, dorsal pedal and plantar arch
Define Arteriosclerosis, arteriolosclerosis, and atherosclerosis
- Arteriosclerosis- hardening of the arteries due to thickening of blood vessel wall (usually medium and large size arteries)
- Arteriolosclerosis - small arteries (hyaline/hyperplastic) (caused by thinks like DM and HTN)
- Atherosclerosis - hardening of arteries specifically due to build up of cholesterol and plauque in tunica intima
what process occurs alongside atherosclerosis
remodelling
Hypercalcaemia can cause what
monckeberg medial calcific sclerosis (tunica media)
Modifiable risk factors for arterial disease
high bp, smoking, DM, physical inactivity, obesity, high blood cholesterol
N-m risk factor for artery disease
race gender age
Fontane classification of PAD
I Asymptomatic
IIa Mild claudication
IIb Moderate-severe claudication
III Ischaemic rest pain
IV ulceration or gangrene
Main symptom of arterial disease
Intermittent claudication- cramp like pain. Arises after walking a set distance, relieved by standing still (unlike neuropathy), not present on first step (unlike OA)
IC common cause
Superficial femoral artery 70% of time
symptom location IC
generally have symptoms from joint above/below artery
Boyd’s classification
3 main symptoms of CAI
Intermittent claudication, rest pain, Ulceration and gangrene (tissue loss)
Describe rest pain
Occurs with limb at rest, felt in foot, worse when lying down and at night, improves with hanging foot out of bed, involvement of Vasa Nervosum, pressure of environment on foot makes it worse
what is vasa nervosum
nerve endings in tunica adventitia- ischaemia causes severe pain
What is critical stenosis
more than 70% occlusion
which bacteria causes gas gangrene
clostridium perfringens
3 types of gangrene
dry wet gas
when do you get wet gangrene
superadded infection
DATES meaning with regards to conservative management of lowering cholesterol
diet alcohol tobacco exercise and stress (avoid recreational drug use)
strongest risk factors
non modifiable - age
modifiable - smoking
Best medical therapy for PAD
Antiplatelets (clopidogrel), statins, PPI
Platelet activation and clopidogrel
Clopidogrel inhibits ADP receptors in platelet activation
- platelet adhesion to vascular injury
- activation of platelets ADP increases expression of GPIIb/IIa receptors
- Cross linking by fibrinogen
Aspirin MOA
inhibits AA -> TXA2
statin MOA
HMG-CoA reductase inhibition - decreased liver cholesterol, increased LDL receptor expression, decreased plasma LDL, decreased VLDL synthesis
2 main long term conditions affecting PAD
DM and HTN
Why are TEDS contraindicated in someone with chronic CAI
will compress the blood vessels further which may result in further ischaemia or occlusion
Get enoxaparin after vte risk assessment instead
acute limb ischaemia important point for clinical examination
6 Ps
pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia
2 surgical options for CAD
Bypass (create a graft to form a collateral channel) or angioplasty (balloon and stent)
least likely to be involved in PAD
brachial artery
only 2 parts of body not involved in peripheral artery disease
heart and aorta
common or internal iliac PAD can cause
decreased blood supply to external genitalia = impotence
Are anticoagulants part of BMT for PAD
no
