vascular disease Flashcards
Pathophysiology of vascular disease
Atherosclerosis
Inflammatory
Vasospastic
Compression
Traumatic
Pro-thrombotic conditions
plaque formation - key points needed to know
progressive
different cellular components of it
end stage unstable plaque that can do several different things- thrombosis/embolism
What happens to the placque when we get an acute clinical complications- ulceration?
- acute thrombosis with occlusion.
- dislodging and peripheral embolism
What happens to the placque when we get an acute clinical complications- thrombosis?
- acute ischaemia/ necrosis
What happens to the placque when we get an acute clinical complications- growth?
chronic ischemia
What happens to the placque when we get an acute clinical complications- necrosis?
aneurysm development
What are the modifiable risk factors in PAD?
Smoking
Hypertension
Diabetes
Hypercholesterolaemia
What are the non- modifiable risk factors in PAD?
Age
Sex
what acute ischaemia occurs in lower limbs?
-6Ps
-Acute-embolus (AF, MI)
-Acute on chronic-thrombus- (different to the embolic event)
what chronic ischaemia occurs in lower limbs?
-IC- intermittent claudificaiton
-Rest pain- end stage of chronic ischaemia
-Tissue loss- insufficient blood so can no longer survive
-Burgers test
what is the anterior circulation in the circle of wills?
MCA
ACA
Anterior choroidal artery
what is the posterior circulation in the circle of wills?
vertebral artery
basilar artery
PCA
CAROTID endarterectomy
local anaesthetic
isolate three vessels: internal external and common carotid with a
clamp
clean out vessels
nice and clear
why do you do a CAROTID endarterectomy
Plaque ulceration and embolisation
symptoms and signs of a stroke
Anterior circulation strokes
Unilateral weakness
Unilateral sensory loss or inattention
- Isolated dysarthria
- Dysphasia
Vision
- Homonymous hemianopia
* Monocular blindness
- Visual inattention
Visceral
Mesenteric and Renal artery disease
what are the different types of aneurysms?
true
false
mycotic
describe true aneurysms
weakening of the arterial wall leading to dilatation
common location is the infra-renal aorta
What information does duplex give you?
duplex is a form of an ultrasound
- info about flow
What are the advantages of MRA over CTA?
cta- involves radiation, nephrotoxicity higher
mra- doesnt involve radiation
what are cross sectional imaging used for?
-to look for aneurysms
- carotid stenoses
treatment for peripheral vascular disease?
Risk factor modification
Antiplatelets
Statin
Stop smoking
Good control of BP
Good control of DM
ACE inhibitors?
Exercise programme
invasive treatment for Lowe limbs to treat endo- vascular problems?
-Stenoses
-Short occlusions
-DEB
-DES
invasive treatment for Lowe limbs to treat bypass surgery problems?
-Better patency and limb salvage rates
-Higher morbidity and mortality
what are the two ways aneurysms in the aorta are treated?
-endovascular
-open surgery
describe endovascular aneurysms in aorta treatment
-Morphology
-Lower morbidity and mortality
-Life long surveillance
describe open surgery aneurysms in aorta treatment
-Higher initial morbidity and mortality
-Lower long term morbidity and mortality
what are the three categories of rare vascular conditions?
- inflammatory
- vaso spastic
-compressive
name 4 inflammatory rarer vascular conditions
Buergers disease
Giant Cell Arteritis
Takayasu
Mixed Connective Tissue
name one vasopressin spastic rarer vascular conditions
Raynauds – Primary/Secondary
name two compressive rarer vascular conditions
Thoracic outlet syndrome
Coeliac compression
lymphatic vascular pathologies
Primary
Secondary – Radiation, Surgery
A-V malformations
Low flow
High Flow
superficial veins
can easily treat
deep veins
more difficult to treat
incompetant deep veins, if back flow- compression
what prevents blood from flowing distally?
Venous return
Valves
Muscle pump
Incompetence
Obstruction
Mixed
clinical presentations of veins
C0 – No signs
C1 – Telangiectasia/reticular
C2 – Truncal
C3 – Oedema
C4 – Skin Changes (Pigmentation/Eczema/LDS)
C5 – Healed ulcer
C6 – Active Ulcer
Pathophysiology
Reflux- blood is going w gravity against where the body wants it to go
Obstruction
Mixed
Where is the SFJ located?
4 patient fingerbreaths lateral and inferior to the pubic tubercle
Treatment of Superficial Venous Disease
Lifestyle
Compression
Sclerotherapy
Endo-venous treatments
Surgical stripping
Treatment of Deep Venous Disease
Lifestyle
Compression
Stents
Valves
MOST IMPORTANT ONE IS COMPRESSION
