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Cardiovascular > SM 137 Peripheral Vascular Disease > Flashcards

SM 137 Peripheral Vascular Disease Flashcards

1
Q

What is Peripheral Arterial Disease?

A

PAD is stenotic or occlusive arterial disease caused by atherosclerosis outside the heart

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2
Q

How can PAD present?

A

PAD may be asymptomatic, but can also present as intermittent claudication and critical limb ischemia

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3
Q

What is intermittent claudication?

A

Claudication is pain caused by a lack of blood flow and can be intermittent with worsening during exercise

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4
Q

What is critical limb ischemia?

A

Severe lack of blood flow to the limbs that results in severe pain and/or gangrene in the limb

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5
Q

How does age affect PAD?

A

PAD worsens with age

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6
Q

How does the extent of symptoms felt in PAD effect survival?

A

Severe symptomatic PAD has worse survival than asymptomatic PAD

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7
Q

How is PAD affected by cadiovascular mortality?

A

PAD in the setting of MI results in greater long term risks of overall cardiovascular mortality

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8
Q

What is the Rutherford Class system?

A

System used to describe Limb Threatening Ischemia, on a scale of 0 - 6

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9
Q

How does asymptomatic PAD compare to CLTI?

A

Asymptomatic PAD tends to result in stable claudication while CLTI tends to result mortality or amputation

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10
Q

What can improve CLTI prognonsis?

A

CLTI tends to progress to amputation and death, with outcomes being improved by revascularization

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11
Q

What are the risk factors for PAD?

A

Atherosclerosis, cigarette smoking, diabetes, hypertension, hyperlipidemia, and family history

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12
Q

Why does CLTI lead to pain at rest in the setting of PAD?

A

A mismatch between arterial supply and demand leads to ischemia, pain, and tissue loss

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13
Q

How does CLTI alter vessels?

A

CLTI can lead to development of collateral flow, but the collateral flow is insufficient; also leads to turbulent flow

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14
Q

How does CLTI compare to intermittent claudication?

A

Both cause pain, intermittent claudication resolves with rest while CLTI does not; CLTI = tissue loss

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15
Q

What options exist for PAD treatment?

A

Medical treatment and Surgical + Medical combination

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16
Q

What does medical treatment for PAD entail?

A

Walking therapy and CV risk factor modification

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17
Q

Who receives medical treatment for PAD?

A

Asymptomatic patients only

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18
Q

What are the surgical treatments for PAD?

A

Endartectomy, bypass graft, and endovascular patients; all in conjunction with medical therapy

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19
Q

Who receives surgical therapy for PAD?

A

Surgical therapy is pursued in PAD patients with symptoms such as CLTI, claudication, etc.

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20
Q

How does CV risk factor modification work?

A

Use CV Risk assessment to treat risk factors such as diabetes, hypertension, smoking, starting statins and antiplatelet therapy

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21
Q

How does walking therapy improve intermittent claudication?

A

Increases pain free walking distance

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22
Q

What is endartectomy?

A

Surgical removal of a plaque from an artery wall, used in symptomatic PAD

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23
Q

What are emerging treatments for PAD?

A

Gene therapy with VEGF and Stem cell therapy with bone marrow; aims to grow blood vessels and improve blood flow

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24
Q

What is Aortic Dissection?

A

Dissection of blood between and along the laminar planes of the media, leading to the formation of a blodo-filled false-lumen

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25
Q

Where is the false lumen in Aortic Dissection found?

A

The false-lumen is found in the aortic wall, between the Intima and Media

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26
Q

How does the false lumen in Aortic Dissection affect perfusion?

A

Blood flow can be seriously occluded during systole as the flap of the false lumen expands and shunts blood into the anuerysmal area

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27
Q

What are the typical traits of someone affected by Aortic Dissection?

A

More common in males, higher in African Americans, predisposed by connective tissue disorders

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28
Q

What are the risk factors for Aortic Dissection?

A

Hypertension, connective tissue disorders, cocaine use

29
Q

What are the possible causes of Aortic Dissection?

A

Medial degeneration and intimal thickening

30
Q

What can cause medial degeneration, and what does this precipitate?

A

Deterioration of medial collagen and elastin as well as loss of smooth muscle cells can lead to Aortic Dissection

31
Q

What can cause intimal thickening, and what does this precipitate?

A

Intimal thickening is caused by fibrosis, calcifications, and fatty acid depositions, which can lead to Aortic Dissection

32
Q

How does Aortic Dissection present?

A

Severe pain + “ripping” sensation + malperfusion syndrome - leads to death if untreated

33
Q

What are the signs of Malperfusion Syndrome?

A

Stroke, ischemia, hypotension

34
Q

Which type of Aortic Dissection precipitates Cardiac Tamponade?

A

Type A Aortic Dissection leads to Cardiac Tamponade

35
Q

What causes Type A Aortic Dissection?

A

Aortic Valve insufficiency, occlusion of coronary vessels, and rupture into the pericardium = surgical emergency

36
Q

Which type of Aortic Dissection is a surgical emergency?

A

Type A, though complicated Type B is also treated with surgery

37
Q

Which of of Aortic Dissection is treated medically?

A

Type B, but only if it’s uncomplicated

38
Q

How does Type B Aortic Dissection present?

A

Occluded branches of the Aorta = Intestinal ischemia, renal failure, leg ischemia

39
Q

How can Type B Aortic Dissection obstruct branch vessels?

A

The neo-intimal flap can obstruct other vessels when the heart contracts

40
Q

How can Aortic Dissection be visualized?

A

Intravascular Ultrasound

41
Q

What can make Type B Aortic Dissection complicated?

A

Malperfusion, rupture, pseudoaneurysm

42
Q

What are the surgical options for treatment of Type B Aortic Dissection?

A

Open thoracoabdomnial aortic replacment and TEVAR

43
Q

How does TEVAR treat Aortic Dissection?

A

Thoracic Endovascular Aortic Repair uses a stent to cover the intimal tear and re-expand true lumen, pushing the flap out of the true lumen

44
Q

What is an Aneurysm?

A

An aneurysm is a widening of the diameter of a vessel by at least 50%

45
Q

What are the risk factors for Abdominal Aortic Aneurysm?

A

Genetics, Hypertension, Age, Gender, Atherosclerosis

46
Q

What underlies the pathophysiology of Abdominal Aortic Aneurysm?

A

Inflammation caused by inflammatory cells result in the release of Matrix metalloproteinases that degrade Collagen and Elastin, leading to thinning of the Media

47
Q

What cells produce MMP’s and where are they found?

A

In the setting of AAA, MMP’s are made by smooth muscle cells, fibroblasts, and inflammatory cells in the wall of the Aorta

48
Q

Which MMP correlates with aneurysm size?

A

MMP-9, underlies pathophysiology of AAA

49
Q

How are Aneurysm’s described?

A

By location, size, shape, and etiology

50
Q

What are possible shapes of aneurysms?

A

Fusiform or saccular

51
Q

How does LaPlace’s Law dictate aneurysm rupture?

A

LaPlace Law: T = P * R; As diameter and pressure rise, wall tension rises, increasing risk of rupture

52
Q

Where can aortic aneurysms be found?

A

Infrarenal, Juxtarenal, Pararenal, Suprarenal

53
Q

What is Marfan syndrome and how does it relate to AAA?

A

Marfan is a congenital Fibrillin-1 defect, predisposes AAA since there is less functional elastic tissue in the Media at birth

54
Q

What is Ehlers-Danlos syndrome and how does it relate to AAA?

A

Ehlers-Danlos is a congenital procollagen defect, predisposes AAA since there is less elastic tissue in the media at birth

55
Q

How can AAA be diagnosed?

A

Abdominal Aortic Aneurysm can be detected and diagnosed with CT scan and Ultrasonography

56
Q

What is the most common form of AAA?

A

Degenerative Abdominal Aortic Aneurysm is the most common form

57
Q

What are Mycotic aneurysms?

A

Aneurysms caused by primary or secondary infection with bacteria or fungi, such as Staph, Salmonella, or Strep

58
Q

Which microorganisms cause Mycotic aneurysms?

A

Staph, Salmonella, Strep

59
Q

What are inflammatory aneurysms?

A

Dense periaortic fibrosis due to inflammation from inflammatory cells

60
Q

What cells cause inflammatory aneurysms?

A

Immune cells = lymphocytes, plasma cells, macrophages, giant cells

61
Q

What arteries does an Infrarenal AAA obstruct?

A

None - the Infrarenal AAA is below the level of the renal arteries

62
Q

What arteries does a Juxtarenal AAA obstruct?

A

None - the Juxtarenal AAA is directly underneath the renal arteries

63
Q

What arteries does a Pararenal AAA obstruct?

A

Both renal arteries, but no arteries above the renal arteries

64
Q

What arteries does a Suprarenal AAA obstruct?

A

Both renal arteries as well as arteries above them, such as the mesenteric artery

65
Q

How does an AAA present?

A

May be asymptomatic, but can also include abdominal or back pain with Aortic rupture causing pain and hypotension

66
Q

What size does an Aortic Abdominal Aorta need to be for repair?

A

Must be greater than 5.5cm in diameter

67
Q

What are the treatment options for AAA?

A

Open repair and endovascular repair

68
Q

How does open repair treat AAA?

A

The patient is surgically operated on to remove the portion of the Aorta with the aneurysm and replace that portion with a graft

69
Q

How does endovascular repair treat AAA?

A

A variety of stents can be inserted via the saphenous vein customized to the patient’s anatomy, with the only restriction being calcified arteries and concomitant aneurysms

Cardiovascular (25 decks)

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