(3) Vascular Disorders Flashcards
What is Monckeberg Medial Sclerosis?
sclerosis of tunica media
What conditions can cause Monckeberg medial sclerosis?
- diabetes mellitus (vasculitis)
- HPT (hypercalcemia)
- SLE (vasculitis)
How does Monckeberg medial sclerosis appear radiographically?
visible arteries past the knee/elbow
What is the most common degenerative arterial disease?
atherosclerosis
What is atherosclerosis?
atheromatous (cholesterol) plaque calcification in intimal and subintimal layers
What is the radiographic finding of atherosclerosis?
conduit wall calcification
(parallel walls of calcium)
What is the relationship between amount of arterial calcification and amount of narrowing of arteries?
poor correlation
What is the relationship between amount of abdominal aorta calcification and stroke risk?
good correlation
What locations of conduit wall calcification would indicate atherosclerosis?
- torso
- neck
- proximal extremities
What diameter of the abdominal aorta is considered abnormal?
> 3cm
What diameter of the abdominal aorta is considered dilation?
3 - 3.5cm
(variable based on pt size)
What diameter of the abdominal aorta is considered an aneurysm?
> 3.5cm
How would you modify your chiropractic treatment based on an aneurysm?
relative contraindication to HVLA, depending on stability
(eg. patient w/ 4cm aneurysm for 10 yrs is probably safe)
What age group is primarily affected by abdominal aortic aneurysms?
> 50 yrs
What is the male to female ratio for abdominal aortic aneurysms?
5:1
What percent of males aged 80 years may experience an abdominal aortic aneurysm?
7-9%
What diameter of abdominal aortic aneurysm has a greater likelihood (75%) of rupturing within 5 years?
7cm
What are some risk factors for abdominal aortic aneurysms?
- ^BP
- smoking
- ^cholesterol
- obesity
- emphysema
- genetics
- male
What are the clinical findings of an abdominal aortic aneurysm?
- 50% ASx
- back pain (viscerosomatic referral, vertebral body ischemia)
What are the clinical findings of a dissecting or ruptured abdominal aortic aneurysm?
- diaphoresis
- rigid abdomen, pulsations
- back or groin pain
- shock, ^HR, anxiety, clammy skin
What percent of abdominal aortic aneurysms will have some degree of calcification on a radiograph?
75%
(radiographs are not sensitive for AAA)
If there is clinical suspicion of a stable abdominal aortic aneurysm, what is your next step?
refer for Doppler ultrasound
If there is concern for an active rupture/dissection of an abdominal aortic aneurysm, what is your next step?
ER transport
What is the first choice for screening for abdominal aortic aneurysms?
Ultrasonography w/ Doppler
What is the 2nd option for screening for abdominal aortic aneurysms which is required for surgical planning?
CT angiography
What is the radiographic finding of an abdominal aortic aneurysm?
cystic calcification
(x-rays not used for Dx, does not show actual size)
What is the average size of a clinically detected abdominal aortic aneurysm?
6.48 cm
What is the average size of a radiographically detected abdominal aortic aneurysm?
5.37 cm
What is the average size of a surgically detected abdominal aortic aneurysm?
5.43 cm
What is the average size of a palpable abdominal aortic aneurysm?
6.42 cm
What are the treatment options for an abdominal aortic aneurysm?
- endovascular stent
- vascular graft
What are the radiographic findings of a vertebral artery calcification?
YOU CANNOT SEE IT YOU SILLY GOOSE
If you suspect a VBA, what is your next step?
ER referral for CT angiogram
