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CSI > vascular disease > Flashcards

vascular disease Flashcards

1
Q

arterial occlusion

A

can occur centrally (Aortoilliac)

but generally start peripherally (Femoral, Popliteal, Infrapopliteal)

Typical Etiology:
Atherosclerosis
Often the first sign of disease elsewhere (CAD)

Other Etiologies:

Diabetes: Distal lower extremities, esp. feet, diabetic foot wounds

Thromboembolic: Limbs

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2
Q

typical arterial occlusion at

A

White, Male, Age 50-60, Smokers

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3
Q

The 5 “P”s of Arterial Occlusion

A 
Pain
Pallor
Pulselessness (weak/absent distal to the occlusion)
Paresthesias
Paralysis (need to intervene!)
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4
Q

Pain

A

Claudication: Severe Cramping associated with exertion
Can be variable, “intermittent”
Inability of blood flow to tissue demands

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5
Q

other manifestations of arterial occlusion

A

Muscle atrophy

Erectile Dysfunction

Loss of hair of distal extremities

Skin Changes:
Hyperemia, Cyanotic, Dusky Appearing, Cool to Touch

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6
Q

arterial occlusion dx:

Ankle-Brachial Index (ABI)

A

The ratio of systolic blood pressure detected by doppler examination at the ankle compared to the brachial artery

Normal: ABI 1.0-1.2

Reduced Blood Flow: ABI less than 0.9

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7
Q

art occ dx: critical limb ischemia

A

Elevated Myglobin (renal failure with rhabdomyalysis)

Metabolic Acidosis

-will be in pain at this point

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8
Q

art occ imaging

A

Angiography with CT or MR

Mainly for Intervention to Identify affected vessels

-look for runoff:
right pic: left leg lacks runoff

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9
Q

art occ conservative tx

A

Exercise, weight loss, smoking cessation

Cilostazol (PDE-inhibitors (maintain patency, inc. blood flood)

Antiplatelet agents (ASA, Clopidogrel)

*prevent extension of clot

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10
Q

art occ tx: Endovascular Techniques

A

Angioplasty and Stenting

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11
Q

art occ tx: sx techniques

A

Endarterctomy

Bypass Grafting

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12
Q

Critical Limb Ischemia tx

A

Heparin
Catheter Directed tPA
Thrombectomy

Complications:
Compartment syndrome
Fasciotomy

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13
Q

aneurysm

types??

A

Pathologic dilation of a BV

saccular (bulge)
fusiform (long and slender)
giant
dissection: high pressure blood flow opens false lumen in intima–>clot, hematoma formation

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14
Q

Diseases Associated with Aneurysms

A

*Aortic Aneurysms
Berry Aneurysms
Peripheral Aneurysms

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15
Q

congenital etiologies of aneurysms

A

Marfans Syndrome: defective elastin gene

Ehler-Danlos Syndrome: defective collagen gene

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16
Q

acquired etiologies of aneurysms

A 
Age
HTN
Smoking, pollution?
Inflammation
Atherosclerosis
Syphilis (mycotic aneurysm)
Trauma
sx procedures i.e. bypass grafts
17
Q

Abdominal Aortic Aneurysm (AAA)

A

Present when Aorta diameter >3cm

Increase risk of rupture >5cm

Found in 2% of men over age 55

90% originate below renal arteries (but before bifurcation)

4:1 Male predominance

18
Q

AAA s/s

A

80% of 5cm infrarenal AAA are palpable
Usually found incidentally on CT or U/S
Pain
Rupture

19
Q

AAA pain

A

Mild-severe abdominal discomfort
Often radiate to the lower back
Intermittent or constant
Exacerbated with abdominal pressure

20
Q

AAA rupture

A

Sudden onset severe pain w/ blood in the retroperitoneum
Palpable mass can be present
Hypotension
medical emergency!

21
Q

AAA imaging: 1st choice

A

Abdominal ultrasound is test of choice:
Screening test
USPTF: recommended in Men 65-74yrs with smoking history (not Women)

22
Q

AAA imaging 2nd choice

A

CT abdomen:
Useful to assess for size and location
Planning for intervention
Monitor Progression

23
Q

conservative AAA tx

A 
Smoking Cessation
Manage HTN
Serial Imaging 
every 2 yrs if less than 4cm
every 6 mos around 5cm
24
Q

elective sx repair for AAA when ??

A

> 5.5cm diameter OR

>0.5cm increase in diameter in 6 months

25
Q

AAA: Absolute Indication for Surgery Consult when ??

A

Signs suggestive of Rupture or impending rupture:
Acute onset severe abdominal pain with radiation to the back
Hypotension
Cullen Sign: periumbilical ecchymosis
Grey Turner’s Sign: flank ecchymosis
(both signs imply retroperitoneal hemorrhage)

26
Q

Thoracic Aortic Aneurysm

s/s

A

less than 10% of all aortic aneurysms

Signs and Symptoms
Severe persistent  substernal chest pain 
Radiation to the back/neck
Usually Hypertensive
Dyspnea, stridor, dysphagia, hoarseness
UE Edema
27
Q

Thoracic Aortic Aneurysm imaging

A 
Chest Xray:
Widened mediastinum 
*CT Chest*:
Modality of Choice
Echocardiography: may see dilated aortic root, bicuspic aortic valve
28
Q

Thoracic Aortic Aneurysm tx: only monitoring when ??

A

Stable Descending Aortic Aneurysm

29
Q

TAA tx: endovascular repair for ??

A

Descending Aortic Aneurysm

30
Q

surgical intervention for TAA

A

Any Ascending Aortic Aneurysm
-Especially when carotid and left subclavian arteries involved
Descending Aortic Aneurysm >6cm in diameter

31
Q

Conditions associated with increased risk of aortic dissection:

A

Pregnancy
Bicuspid aortic valve
Coarctation of the Aorta

32
Q

aortic dissection s/s

A 
Severe persistent  substernal chest pain 
Radiation to the back/neck
Usually Hypertensive
Dyspnea, stridor, dysphagia, hoarseness
UE Edema
Diastolic Murmur
Intestinal ischemia
Diminished /unequal peripheral pulses
Acute Heart Failure
Pericardial Tamponade
33
Q

aortic dissection imaging

A

CT Chest and abdomen: modality of choice

see false lumen

34
Q

aortic dissection med tx

A

Aggressive HTN management
Beta blockers, Nitroprusside
Morphine for pain

35
Q

aortic dissection sx

A

Urgent
all Type A
Type B affecting left subclavian artery

36
Q

Venous Insufficiency May be associated with ??

A 
Obesity
Previous leg trauma
Previous DVT
Varicose veins
Neoplastic obstruction
AV fistula (congenital or acquired)
37
Q

Venous Insufficiency basic pathology

A

Valve leaflets do not close
Increased Hydrostatic Pressure
Causes characteristic Skin changes

38
Q

venous insufficiency s/s

A 
Progressive Pitting Edema
Secondary skin changes:
Edema (pitting)
Fibrosis
Hyperpigmentation-Hemosiderin deposition
Thickening of the subcutaneous tissue
Pruritis
Ulceration
Impaired wound healing
decreased sensation
lack of hair
dusky appearance, dec. sensation, cooler
NOT cellulitis (would be warm)
39
Q

venous insufficiency tx

A

Fitted Graduated Compression Stockings
Avoidance of long periods of time sitting/standing
Intermittent elevation

CSI (75 decks)

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