Vascular Disease

Question 1

Arteries are a high pressure system. Venous return follows arterial supply as _________. Gas exchange occurs in the __________.

Answer 1

a low pressure system

capillaries

Question 2

Arterial Occlusion-
Can occur centrally: _________
Generally start peripherally: ___________

Answer 2

Aortoilliac

Femoral Popliteal, Infrapopliteal

Question 3

Typical etiology is ___________

Answer 3

Atherosclerosis

Often the first sign of disease elsewhere (CAD)

Question 4

Diabetes will show arterial occlusions in

Answer 4

distal lower extremities, esp. feet, diabetic foot wounds

Question 5

Thromboembolic arterial occlusions will occur in

Answer 5

limbs

Question 6

Epidemiology

Answer 6

White, Male, Age 50-60, Smokers

Question 7

S/S (5 Ps of arterial occlusion)

Answer 7

1. Pain (Claudication: Severe Cramping associated with exertion; Can be variable/ “intermittent”; Inability of blood flow to tissue demands)
2. Pallor
3. Pulselessness (Weak or Absent distal to the occlusion)
4. Paresthesias
5. Paralysis

Question 8

Other S/S of arterial occlusion

Answer 8

• Muscle atrophy
• Erectile Dysfunction
• Loss of hair of distal extremities
• Skin Changes: Hyperemia, Cyanotic, Dusky Appearing, Cool to Touch

Question 9

Use Ankle-Brachial Index (ABI) to diagnose

Answer 9

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

Question 10

ABI ranges

Answer 10

Normal 1.0-1.2

Reduced Blood Flow ABI

Question 11

Critical limb ischemia will show

2 things

Answer 11

Elevated Myglobin

Metabolic Acidosis

Question 12

Imagine for arterial occlusion

Answer 12

Angiography with CT or MR; mainly for Intervention to Identify affected vessels

Question 13

Conservative treatment for arterial occlusion

Answer 13

Exercise, weight loss, smoking cessation, Cilostazol (PDEi), Antiplatelet agents (ASA, Clopidogrel)

Question 14

Endovascular techniques for arterial occlusion

Answer 14

Angioplasty and Stenting

Question 15

Surgical techniques for arterial occlusion

Answer 15

Endarterctomy, Bypass Grafting

Question 16

Treatment for Critical Limb Ischemia

Answer 16

• Heparin
• Catheter Directed tPA
• Thrombectomy

*Complication may be compartment syndrome –> to treat do fasciotomy

Question 17

Aneurysm

Answer 17

Pathologic dilation of a blood vessel

Aortic Aneurysms
Berry Aneurysms
Peripheral Aneurysms
-diseases associated with these

Question 18

Congenital causes of aneurysms

Answer 18

Marfans Syndrome: defective elastin gene

Ehler-Danlos Syndrome: defective collagen gene

Question 19

Factors that can cause aneurysms

Answer 19

Age
HTN
Smoking, pollution?
Inflammation
Atherosclerosis
Syphilis
Trauma

Question 20

Abdominal Aortic Aneurysm (AAA) 5 facts

Answer 20

1. Present when Aorta diameter >3cm
2. Increase risk of rupture >5cm
3. Found in 2% of men over age 55
4. 90% originate below renal arteries
5. 4:1 Male predominance

Question 21

S/S of AAA

Answer 21

• 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

Question 22

When AAA ruptures

Answer 22

1. Sudden onset severe pain with blood in the retroperitoneum
2. Palpable mass can be present
3. Hypotension

Question 23

Imaging for AAA

Answer 23

1. Abdominal ultrasound is #1
   Screening test; recommended in Men 65-74yrs with smoking history (not Women)
2. CT abdomen
   Useful to assess for size and location, Planning for intervention,
   Monitor Progression

Question 24

Conservative treatment/management for AAA

Answer 24

• Smoking Cessation
• Manage HTN
• Serial Imaging: Every 2 yrs

Question 25

Elective Surgical Repair if size of AAA is

Answer 25

>5.5cm diameter or >0.5cm increase in diameter in 6 months

Question 26

Absolute Indication for Surgery Consult when

Answer 26

- 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

Question 27

Grey Turner Sign

Answer 27

bruising on flank/side of body

Question 28

Cullen's Sign

Answer 28

bruising around umbilicus

Question 29

Thoracic Aortic Aneurysm S/S | (

Answer 29

- Severe persistent substernal chest pain - Radiation to the back/neck - Usually Hypertensive - Dyspnea, stridor, dysphagia, hoarseness - UE Edema

Question 30

Imaging for Thoracic Aortic Aneurysm

Answer 30

1. *Chest CT* Modality of Choice 2. Chest Xray- Widened mediastinum 3. Echocardiography

Question 31

Treatment for Thoracic Aortic Aneurysm

Answer 31

1. Monitoring (Stable Descending Aortic Aneurysm 6cm in diameter

Question 32

Aortic Dissections (3 types)

Answer 32

DeBakey I, II, III (pictures)

Question 33

Conditions associated with increased risk of aortic dissection

Answer 33

1. Pregnancy 2. Bicuspid aortic valve 3. Coarctation of the Aorta

Question 34

S/S of Aortic Dissection

Answer 34

- 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

Question 35

Imaging used for Aortic Dissection

Answer 35

CT Chest and abdomen

Question 36

Medical treatment for Aortic Dissection

Answer 36

Aggressive HTN management Beta blockers, Nitroprusside Morphine for pain

Question 37

Surgical Treatment for which Aortic Dissections?

Answer 37

* all Type A | * Type B affecting left subclavian artery

Question 38

Venous insufficiency may be associated with

Answer 38

``` Obesity, Previous leg trauma, Previous DVT Varicose veins Neoplastic obstruction AV fistula (congenital or acquired) ```

Question 39

Pathology of venous insufficiency

Answer 39

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

Question 40

S/S of venous insufficiency

Answer 40

1. Progressive Pitting Edema 2. 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.

Question 41

treatment for venous insufficiency

Answer 41

1. Fitted Graduated Compression Stockings 2. Avoidance of long periods of time sitting/standing 3. Intermittent elevation