Vascular System Flashcards
Atherosclerosis
common plaque locations: coronary arteries, carotid bifurcation, proximal ilia arteries, adductor canal region of distal superificial femoral arteries
common sequelae: MI or angina pectoris; TIA or stroke; lower extremity ischemia
Aneurysms
true or pseudoaneurysms
most likely in infrarenal aorta, iliac arteries, and popliteal arteries.
increased levels MMP-2 and MMP-9
associated with atherosclerosis.
Features: incidental finding of pulsatile mass, pain, thrombosis, distal embolization, rupture
Dx: PE, US, CT
Tx: >5.5cm in men or 4.5cm in women = surgical repair open or endovascular via graft.
rupture = back pain, hypotension, and pulsatile abdominal mass
Complications = infection, aortoenteric fistula, graft thrombosis, colonic ischemia
Endoleaks
"ECHPE" Type 1 = ends leak Type 2 = collaterals via lumbar or IMA Type 3 = holes in graft Type 4 = porosity, diffusion through the graft Type 5 = endotension, can't see leak
Aortic Dissection
tear of intima into media of aortic wall.
Type A = ascending aorta
Tx: emergent surgery
Type B = descending aorta
Tx: lower BP/HR, decrease velocity of left ventricular contraction
Features: severe tearing chest pain.Dx: double barrelled aorta
Dx: transesophageal echo, CT, angiography
PAD
aka peripheral arterial occlusive disease
cause: occlusion or stenosis of arteries of lower extremities
Features: intermittent claudication, ischemic rest pain, skin ulceration, gangrene, loss of hair on distal aspect of leg, muscle atrophy, color changes in leg.
Dx: pulses on exam, Doppler of pulses, ABI <0.9, MRA, CTA
Tx: antiplatelet therapy, beta blocker, percutaneous transluminal angioplasty, balloon stents, atherectomy, endarterectomy for carotid atherosclerosisy, bypass procedures, amputation
Dry Gangrene
mummification of digits of foot without associated purulent drainage or cellulitis
Wet Gangrene
associated with ongoing infection.
Chronic Intestinal Ischemia
cause: occlusion of celiac axis, SMA, IMA.
Features: postprandial abd pain, weight loss
Dx: history, duplex US, CTA, mesneteric angiography, MRA
Tx: mesenteric revascularization, proximal mesenteric artery balloon angioplasty and stenting, endarterectomy, bypass
Renovascular HTN
cause: atherosclerosis, fibromuscular dysplasia, trauma
associated with poorly controlled BP, ischemic nephropathy
1. atherosclerosis = proximal part of renal artery
Tx: angioplasty and stenting
2. fibromuscular dysplasia = middle to distal portion of renal artery
Tx: percutaneous transluminal balloon angioplasty
Features: HTN, epigastric or flank bruit
Dx: renal duplex, renal function studies, CTA, MRA, captopril test, catheter renal arteriography
Tx: renal revascularization, surgical bypass
Acute Arterial Occlusion
cause: in situ thrombosis, embolus, trauma
sites of embolization: femoral artery, axillary, popliteal, iliac, aortic bifurcation, mesenteric arteries.
Features: pallor, pain, paresthesia, paralysis, pulselessness, poikilothermia
Dx: CT with IV contrast
Tx: anticoagulation, fluid resuscitation, correct acidosis, surgery for thrombectomy or embolectomy if emergent,
Systemic Ischemia-Reperfusion Syndrome
Features: compartment syndrome, hyperkalemia, metabolic acidosis, myoglobinuria, renal/pulmonaryinsufficiency.
Tx: hydration, alkalinization of urine, fascial decompression
Cerebrovascular Insufficiency
cause: occlusive, ulcerative, or aneurysmal disease of carotid or vertebral arteries.
can cause stroke (CVA)
Features: amaurosis fugax (fleeting blindness), changes in mentation, vision, sensorimotor, permanent neuro deficits if stroke
Dx: CT or MRI
Tx: control risk factors, antiplatelet (asparin, clopidogrel), anticoag (warfarin)
Vertebral Basilar Disease
aka subclavian steal syndrome
Features: posterior cerebral and cerebellar ischemia, light-headedness, syncope with arm exercise, supraclavicular bruit, uneven arm BP
Tx: carotid-subclavian bypass, subclavian angioplasty, reimplant subclavian artery into proximal common carotid
Superficial Vein Thrombosis
cause: IV catheters, sclerotherapy
Features: swelling, erythema, tenderness
Tx: NSAIDs, warm compresses, excision, thrombectomy
DVT
Features: many asymptomatic, local pain from inflammation and edema, unilateral leg swelling, pain with dorsal felxion of foot (Homan’s sign)
Dx: duplex scan, D-dimer, evaluate for protein C/protein S/antithrombin 3/factor V Leiden/prothrombin mutation and anticardiolipin Ab.
Tx: heparin then warfarin for INR 2-3, tPA (for SVA occlusion, subclavian vein thrombosis, acute renal thrombosis), mechanical thrombectomy
PE
aka pulmonary embolism
Features: pleuritic chest pain, dyspnea, tachypnea, tachycardia, cough, and hemoptysis, right-sided heart strain on EKG.
Prevention: anticoag in high risk group
Dx: spiral CT with wedge-shaped or lobar defect, pulmonary angiogram
Tx: anticoagulation, IVC filter
Varicose Veins
Primary = superficial veins.
cause: incompetence of venous valve at junction of saphenous and femoral vein in inguinal region
Features: heaviness and fatigue after prolonged standing, night cramps, occasionally ankle edema, superficial thrombophlebitis, hemorrhage of superficial veins.
Dx: duplex US
Tx: stripping of saphenous vein, saphenous ligation, radiofrequency ablation, stab phlebotomy
Chronic Venous Insufficiency
cause: local venous HTN
Features: swollen legs, hyperpigmentation, venous ulceration in gaiter zone of ankle, lipodermatosclerosis, orange-brown skin at ankle, superficial varicosities.
Dx: venous duplex US, MRI/MRV, CT venogram
Tx: compression stockings, wound care, springing/removal/RFA/laser of superficial veins, interruption of perforating veins, STSG
AVM and AVF
aka arteriovenous malformation or fistula
AVM is congenital
Features: thrill and bruit over site, hyperpigmentation, mass, swelling, pain, musculoskeletal disability
Dx: MRI, MRA, CTA
Tx: surgical excision
AVF is acquired, sometimes for dialysis. associated with pseudoaneurysms Features: thrill and bruit Dx: duplex US Tx: surgical repair.
Raynaud syndrome
cause: cold or emotionally induced episodic digital ischemia
Features: female, 50% with autoimmune disease (scleroderma, lupus, etc).
3 phases:
1. white = profound vasospasm causes blanching
2. blue = cyanosis after 15 min from delayed venous emptying
3. red = when flow restored.
Dx: history, phsical, confirm autoimmune disease, doppler
Tx: discontinue ergotamines and beta blockers, use CCBs and alpha blockers, xylocaine
Thoracic Outlet Syndrome
cause: compression of brachial plexus, arteries, veins, elongated transverse process of 7th cervical vertebra, cervical rib, marrowed costoclavicular space.
Features: young and middle aged women, paresthesias of arm and hand, cold arm, pallor, muscle fatigue, subclavian aneurysm.
Dx: history, Adson’s test (radial pulse disappears on arm abduction and external rotation), cervical xray, nerve conduction velocity
Tx: PT, botox, surgical decompression
Lymphedema
Primary = congenital (birth), lymphedema praecox (10-15hr), lypmhedema tarda (after 35yr)
Secondary = from infection, radiation, surgery, neoplastic invasion
Features: diffuse painless extremity enlargement, pitting to woody edema
Tx: compression devices, foot care, abx, elevation, bed rest if infection, surgery if fails (lymphangioplasty or excision)
Increased risk of lymphangiosarcoma
