Aneurysms and Vascular Disease

Question 1

What is PAD?

Answer 1

Thickening of the arteriole wall, causing narrowing/stenosis to the artery

Question 2

What does PAD lead to?

Answer 2

Decreased perfusion of blood to the extremities

Question 3

What is the leading cause of PAD?

Answer 3

Atherosclerosis

Question 4

What are risk factors for PAD?

Answer 4

Tobacco use
DM
Hyperlipidemia
Uncontrolled HTN
Obesity
Sedentary lifestyle
Stress

Question 5

How does tobacco contribute to PAD?

Answer 5

Nicotine is a potent vasoconstrictor
Impairs transport and cellular use of O2
Increases blood viscosities

Question 6

What is a clinical manifestation of PAD?

Answer 6

Intermittent claudication (during exercise)
- Cramping from decreased blood flow and muscles not receiving enough O2 -> anaerobic metabolism

Question 7

What are some complications from PAD?

Answer 7

Amputation

Ulcers from decreased circulation

Question 8

How is PAD diagnosed?

Answer 8

Doppler studies
Ankle-brachial indexes
Angiography
MRI testing

Question 9

How is PAD treated?

Answer 9

Smoking cessation
Exercise
Maintaining an ideal body weight
Reviewing diet
Addressing BP issues
Drug therapy - oral antiplatelet (Aspirin or Plavix)
Surgery (bypass grafting)

Question 10

What is venous thrombus disease?

Answer 10

Formation of clots in the venous system

Question 11

What are the classifications of venous thrombus disease?

Answer 11

Superficial vein thrombosis
DVT
Venous thromboembolim

Question 12

What is superficial vein thrombosis?

Answer 12

Formation of a thrombus in the superficial vein

Usually greater or lesser saphenous veins

Question 13

What is DVT?

Answer 13

Thrombus in a deep vein

Usually in iliac or femoral vein

Question 14

What is Virchow’s triad?

Answer 14

Three main contributing factors to the development of venous thromboembolism
Venous stasis
Damage of endothelium
Hypercoagulability of the blood

Question 15

How does a patient with a venous clot present?

Answer 15

Lower extremity VTE may or may not have edema
May complain of tenderness on palpation
May have dilated superficial veins
May complain of a sense of fullness
Skin may be warm, reddened, or may have a temp >104

Question 16

What diagnostic testing can be used for venous disease?

Answer 16

Duplex study
Ultrasound
Blood studies
PTT, INR, bleeding time, HgB, HCt, platelet count
CT scan venography
MRI

Question 17

What drugs can be used for VTE?

Answer 17

Warfarin/Coumadin to avoid further clotting
Heparin to prevent further clotting
Low molecular weight heparin (Lovonox)
Acava and Prodaxa

Question 18

PAD vs venous disease pulses:

Answer 18

PAD pulses: weak

venous disease pulses: bounding

Question 19

PAD vs venous disease cap refill:

Answer 19

PAD cap refill: >3 seconds

venous disease cap refill: <3 second

Question 20

PAD vs venous disease edema:

Answer 20

PAD: usually no edema

venous disease edema: common in lower legs

Question 21

PAD vs venous disease hair:

Answer 21

PAD: can be loss of hair

venous disease: can be loss of hair

Question 22

PAD vs venous disease pain:

Answer 22

PAD: intermittent claudication

venous disease: may complain of dull, achy pain, or heaviness

Question 23

PAD vs venous disease nails:

Answer 23

PAD: thickened, brittle nails

venous disease: normal or slightly thickened nails

Question 24

PAD vs venous disease skin:

Answer 24

PAD: cool skin that will get cooler toward distal extremity

venous disease: thick, hardened, indurated (raised) skin

Question 25

PAD vs venous disease pruritis:

Answer 25

PAD: no pruritis | venous disease: complains of pruritis

Question 26

PAD vs venous disease skin color:

Answer 26

PAD: feet can be red in color if in dependent position; elevated feet will appear pale venous disease: feet can be red to brown/bronze from pooling of blood

Question 27

PAD vs venous disease optimal positioning:

Answer 27

PAD: dependent extremity to aid flow of blood from heart to extremity venous disease: feet elevated above heart to assist gravity in moving blood towards heart

Question 28

What is an aneurysm?

Answer 28

A permanent, localized dilation/outpouching of a blood vessel wall

Question 29

Which gender are aneurysms more common in?

Answer 29

Men

Question 30

How are aneurysms classified?

Answer 30

True | False

Question 31

What is a true aneurysm and what are the 2 subclassifications?

Answer 31

The wall of the artery forms an aneurysm with at least one vessel layer still in tact Fusiform aneurysm: circumferential and uniform in shape - circle entire aorta Saccular aneurysm: pouch-like, with narrow neck connecting bulge of one side of the arterial wall

Question 32

What is a false aneurysm?

Answer 32

Disruption of the arterial wall layer with bleeding contained by surrounding anatomic structures

Question 33

What type of aneurysm is the most common site for dissection?

Answer 33

Thoracic aneurysms

Question 34

What is a dissection?

Answer 34

Different layers of the artery separating or tearing from each other

Question 35

What are signs of aneurysms?

Answer 35

Pain - can radiate to scapular area | Dypsnea, cough, hoarseness, dysphagia

Question 36

Why can people with abdominal aortic aneurysms "feel their heart beating"?

Answer 36

Due to an outpouching of the wall

Question 37

What is a hallmark complaint of an AAA?

Answer 37

Lower back pain

Question 38

What issues can an AAA lead to?

Answer 38

Dissection of the aorta | Rupture

Question 39

What is an aortic rupture?

Answer 39

Hole is created within the aorta - blood is released into the cavity and pt is at high risk for exsanguination

Question 40

How can you diagnose an AAA?

Answer 40

Ultrasound Xray MRI Angiography

Question 41

How do you decide between a medical and surgical treatment for an AAA?

Answer 41

Size Small aneurysms will be followed with frequently ultrasounds Large or growing aneurysms will receive grafting