Vascular Disease Flashcards
Arteries are a high pressure system. Venous return follows arterial supply as _________. Gas exchange occurs in the __________.
a low pressure system
capillaries
Arterial Occlusion-
Can occur centrally: _________
Generally start peripherally: ___________
Aortoilliac
Femoral Popliteal, Infrapopliteal
Typical etiology is ___________
Atherosclerosis
Often the first sign of disease elsewhere (CAD)
Diabetes will show arterial occlusions in
distal lower extremities, esp. feet, diabetic foot wounds
Thromboembolic arterial occlusions will occur in
limbs
Epidemiology
White, Male, Age 50-60, Smokers
S/S (5 Ps of arterial occlusion)
- Pain (Claudication: Severe Cramping associated with exertion; Can be variable/ “intermittent”; Inability of blood flow to tissue demands)
- Pallor
- Pulselessness (Weak or Absent distal to the occlusion)
- Paresthesias
- Paralysis
Other S/S of arterial occlusion
- Muscle atrophy
- Erectile Dysfunction
- Loss of hair of distal extremities
- Skin Changes: Hyperemia, Cyanotic, Dusky Appearing, Cool to Touch
Use Ankle-Brachial Index (ABI) to diagnose
The ratio of systolic blood pressure detected by doppler examination at the ankle compared to the brachial artery
ABI ranges
Normal 1.0-1.2
Reduced Blood Flow ABI
Critical limb ischemia will show
2 things
Elevated Myglobin
Metabolic Acidosis
Imagine for arterial occlusion
Angiography with CT or MR; mainly for Intervention to Identify affected vessels
Conservative treatment for arterial occlusion
Exercise, weight loss, smoking cessation, Cilostazol (PDEi), Antiplatelet agents (ASA, Clopidogrel)
Endovascular techniques for arterial occlusion
Angioplasty and Stenting
Surgical techniques for arterial occlusion
Endarterctomy, Bypass Grafting
Treatment for Critical Limb Ischemia
- Heparin
- Catheter Directed tPA
- Thrombectomy
*Complication may be compartment syndrome –> to treat do fasciotomy
Aneurysm
Pathologic dilation of a blood vessel
Aortic Aneurysms
Berry Aneurysms
Peripheral Aneurysms
-diseases associated with these
Congenital causes of aneurysms
Marfans Syndrome: defective elastin gene
Ehler-Danlos Syndrome: defective collagen gene
Factors that can cause aneurysms
Age HTN Smoking, pollution? Inflammation Atherosclerosis Syphilis Trauma
Abdominal Aortic Aneurysm (AAA) 5 facts
- Present when Aorta diameter >3cm
- Increase risk of rupture >5cm
- Found in 2% of men over age 55
- 90% originate below renal arteries
- 4:1 Male predominance
S/S of AAA
- 80% of 5cm infrarenal AAA are palpable
- Usually found incidentally on CT or U/S
- Pain: Mild-sever abdominal discomfort, Often radiate to the lower back, Intermittent or constant, Exacerbated with abdominal pressure
When AAA ruptures
- Sudden onset severe pain with blood in the retroperitoneum
- Palpable mass can be present
- Hypotension
Imaging for AAA
-
Abdominal ultrasound is #1
Screening test; recommended in Men 65-74yrs with smoking history (not Women) - CT abdomen
Useful to assess for size and location, Planning for intervention,
Monitor Progression
Conservative treatment/management for AAA
- Smoking Cessation
- Manage HTN
- Serial Imaging: Every 2 yrs
Elective Surgical Repair if size of AAA is
> 5.5cm diameter or >0.5cm increase in diameter in 6 months
Absolute Indication for Surgery Consult when
- Signs suggestive of Rupture or impending rupture
- Acute onset severe abdominal pain with radiation to the back
- Hypotension
- Cullen Sign, Grey Turner’s Sign-retroperitoneal hemorrhage
Grey Turner Sign
bruising on flank/side of body
Cullen’s Sign
bruising around umbilicus
Thoracic Aortic Aneurysm S/S
(
- Severe persistent substernal chest pain
- Radiation to the back/neck
- Usually Hypertensive
- Dyspnea, stridor, dysphagia, hoarseness
- UE Edema
Imaging for Thoracic Aortic Aneurysm
- Chest CT Modality of Choice
- Chest Xray- Widened mediastinum
- Echocardiography
Treatment for Thoracic Aortic Aneurysm
- Monitoring (Stable Descending Aortic Aneurysm 6cm in diameter
Aortic Dissections (3 types)
DeBakey I, II, III (pictures)
Conditions associated with increased risk of aortic dissection
- Pregnancy
- Bicuspid aortic valve
- Coarctation of the Aorta
S/S of Aortic Dissection
- 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
Imaging used for Aortic Dissection
CT Chest and abdomen
Medical treatment for Aortic Dissection
Aggressive HTN management
Beta blockers, Nitroprusside
Morphine for pain
Surgical Treatment for which Aortic Dissections?
- all Type A
* Type B affecting left subclavian artery
Venous insufficiency may be associated with
Obesity, Previous leg trauma, Previous DVT Varicose veins Neoplastic obstruction AV fistula (congenital or acquired)
Pathology of venous insufficiency
- Valve leaflets do not close
- Increased Hydrostatic Pressure
- Causes characteristic Skin changes
S/S of venous insufficiency
- Progressive Pitting Edema
- Secondary skin changes:
Edema
Fibrosis
Hyperpigmentation-Hemosiderin deposition
Thickening of the subcutaneous tissue
Pruritis
Ulceration
Impaired wound healing
Skin will have lack of hair, not warm, “dusty” purple/bruised appearance, not red.
treatment for venous insufficiency
- Fitted Graduated Compression Stockings
- Avoidance of long periods of time sitting/standing
- Intermittent elevation
