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CMT > Arterial Diseases > Flashcards

Arterial Diseases Flashcards

1
Q

Aorta

three layers of the aorta

A
  1. tunica intima (thin, innermost)
  2. tunica media (thick, middle)
  3. tunica adventitia (thin, outermost)
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2
Q

Aorta

3 conditions of the aorta

A
  1. aneurysm
  2. dissection
  3. rupture
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3
Q

Aorta

describe aortic aneurysm

general, 2 statements

A
  1. dilatation of the aorta (> 3 cm(
  2. involves all 3 layers of the vessel wall
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4
Q

Aorta

describe aortic dissection

general

A

tear of the tunica intima which creates a false lumen

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5
Q

Aorta

describe aortic rupture

A

full-thickness tear of aorta

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6
Q

Aortic Aneurysm

3 types?

A
  1. thoracic aortic aneurysm (TAA)
  2. thoracoabdominal aortic aneurysm
  3. abdominal aortic aneurysm (AAA)
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7
Q

Aortic Aneurysm

what does TAA involve?

A
  • thoracic aortic aneurysm
  • involves aortic root, ascending aorta, arch, and descending aorta above diaphragm
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8
Q

Aortic Aneurysm

what does thoracoabdominal aortic aneurysm involve?

A

involves descending thoracic aorta and abdominal aorta

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9
Q

Aortic Aneurysm

what does AAA involve?

A
  • abdominal aortic aneurysm
  • involves descending aorta below diaphragm
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10
Q

Abdominal Aortic Aneurysm

90% of AAA most commonly occur where?

A

in the segment of aorta between the renal arteries and the bifurcation of the aorta

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11
Q

Abdominal Aortic Aneurysm

more common in who?
occurs in what % of them over 55 y/o?

A
  • male > female
  • 2% of men over 55 y/o
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12
Q

Abdominal Aortic Aneurysm

risk factors

7 things

A
  1. advanced age
  2. male
  3. tobacco use
  4. alcohol use
  5. white
  6. family hx
  7. atherosclerotic disorders (HTN, hyperlipidemia)
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13
Q

Abdominal Aortic Aneurysm

protective factors

4

A
  1. female
  2. not white
  3. diabetes
  4. moderate alcohol consumption
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14
Q

Abdominal Aortic Aneurysm

how large does an AAA need to be to be consistently found on PE?

A

> 5 cm

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15
Q

Abdominal Aortic Aneurysm

how are asx AAA found?

A

incidental findings on abd ultrasound or CT imaging

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16
Q

Abdominal Aortic Aneurysm

clinical findings when symptomatic?

A
  • mild to severe deep abd pain
  • flank pain that is constant or intermittent
  • pain exacerbated on palpation
  • pain radiates to back
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17
Q

Abdominal Aortic Aneurysm

complication

A

RUPTURE
has poor prognosis

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18
Q

Abdominal Aortic Aneurysm

risk of rupture drastically increases when diameter is > than?

A

5.5 cm

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19
Q

Abdominal Aortic Aneurysm

what are 2 imaging options? (which is preferred?)

A
  1. abdominal ultrasound (DO THIS ONE)
  2. abdominal CT w/ contrast
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20
Q

Abdominal Aortic Aneurysm

what will abd CT w/ contrast allow you to do?

A
  • assess the diameter
  • visualize arteries above/below to help plan surgical repair
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21
Q

Indications for surgical repair?

A
  1. diameter > 5.5cm
  2. rapid expansion in diameter ( > 0.5 cm in 6 mo)
  3. symptomatic (indicates impending rupture)
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22
Q

which of the following is not an indication for referal for surgical intervention?
1. increase in size > 0.8cm in 1 yr
2. active back/abd pain
3. hx of marfan’s syndrome
4. HTN

A

HTN

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23
Q

Abdominal Aortic Aneurysm

2 repairs that can be done

A
  1. open surgical repair
  2. endovascular repair
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24
Q

Abdominal Aortic Aneurysm

describe open surgical repair

A

graft sutured into the superior and inferior non-dilated aorta

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25
Q

Abdominal Aortic Aneurysm

what are the considerations for open surgical repair

3

A
  1. cardiopulmonary risk assessment
  2. abdominal adiposity
  3. abdominal incision
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26
Q

Abdominal Aortic Aneurysm

complications of open surgical repair

A
  • myocardial infarction
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27
Q

Abdominal Aortic Aneurysm

mortality rate of open surgical repair

A

1-5%

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28
Q

Abdominal Aortic Aneurysm

describe endovascular repair

A
  • stent graft introduced through femoral arteries
  • placed via fluoroscopic guidance
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29
Q

Abdominal Aortic Aneurysm

considerations of endovascular repair

2

A
  1. reduced intraoperative morbidity and mortality
  2. shorter recovery period
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30
Q

Abdominal Aortic Aneurysm

mortality rate of endovascular repair?

A

0.5-2%

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31
Q

Abdominal Aortic Aneurysm

Long term survival for either surgical repair option?

A
  • equivalent for both procedures
  • 60% of pts are alive after 5 years
  • MI is leading cause of death
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32
Q

Abdominal Aortic Aneurysm

which surgical repair carries more intraoperative risk? which carriers more post-op risk?

A
  1. open repair more risk intraoperatively
  2. endovascular repair more post-operative complications
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33
Q

Abdominal Aortic Aneurysm

one time screening

how, who, why, outcome?

A
  1. abd US
  2. men 65-75 y/o
  3. family hx, smoking hx
  4. decreased risk of AAA-related mortality
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34
Q

Abdominal Aortic Aneurysm

management & disposition of asx w/ diameter of:
* < 5.5 cm
* > 4.5 cm
* > 5.5 cm

A
  1. periodic clinical surveillance, risk reduction strategies
  2. refer to vascular surgery
  3. elective open vs endoscopic repair
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35
Q

Abdominal Aortic Aneurysm

management & disposition of symptomatic AAA

A
  1. admit for observation and surgical risk assessment
  2. determine if pt is a candidate for surgical repair
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36
Q

Thoracic Aortic Aneurysm

Risk Factors

5 groups: 3, 2, 2, 1, 1

A
  1. idiopathic/degenerative (atherosclerosis, HTN, smoking)
  2. aortitis (takayasu arteritis, giant cell arteritis)
  3. connective tissue disorders (Marfan’s, Ehlers-Danlos)
  4. Bicuspid aortic valve
  5. family hx of TAA
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37
Q

Thoracic Aortic Aneurysm

what do sx depend on?

A

size, position, and rate of growth of aneurysm

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38
Q

Thoracic Aortic Aneurysm

clinical presentation

6 components

A
  • can be asx
    1. dysphagia
    2. stridor, dyspnea
    3. SVC: upper extremity edema, jugular venous distension
    4. Aortic root: aortic regurgitation
    5. substernal chest pain
    6. pain radiating to back/neck
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39
Q

Thoracic Aortic Aneurysm

complication of being symptomatic

A

rupture

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40
Q

Thoracic Aortic Aneurysm

imaging options

A
  1. CXR
  2. CT angiography
  3. transescophagel or transthoracic echocardiogram
41
Q

Thoracic Aortic Aneurysm

when is CXR useful?

A

initial evaluation

42
Q

Thoracic Aortic Aneurysm

when is CT angiography most useful?

A

best initial imaging for pts suspected to have TAA

43
Q

Thoracic Aortic Aneurysm

when is a transesophageal or transthroacic echocardiogram useful?

A

further evaluation

44
Q

Thoracic Aortic Aneurysm

indications for surgical repair?

3

A
  1. diameter > 5.5 cm
  2. symptomatic
  3. pts with genetic conditions that increase risk of rupture
45
Q

Thoracic Aortic Aneurysm

surgical repair options

2

A
  1. open
  2. endovascular
46
Q

Thoracic Aortic Aneurysm

describe open surgical repair

A
  • ascending aortic arch
  • requires skilled CT surgery team
  • assess the cardiopulmonary risk of an open surgery
47
Q

Thoracic Aortic Aneurysm

complications of open surgery?

A
  1. stroke
  2. neurologic injury
48
Q

Thoracic Aortic Aneurysm

describe endovascular repair?

A

descending thoracic aorta

49
Q

Thoracic Aortic Aneurysm

complications of endovascular repair?

1

A
  1. paraplegia (4-10%)
50
Q

Thoracic Aortic Aneurysm

3 components of management and disposition of asx patients with diameter < 5.5 cm:

A
  1. refer to CT surgery
  2. Annual surveillance, modifiable based on site, size, hx
  3. CT or MR angiography
51
Q

Thoracic Aortic Aneurysm

management and disposition of asx disease in patients with diameter > 5.5 cm?

A

consult/refer to CT surgery or vascular specialist for surgical repair

52
Q

Thoracic Aortic Aneurysm

management and disposition of symptomatic disease?

A

consult CT surgery for surgical repair

53
Q

Aortic Rupture

risk factors?

2

A
  1. blunt force trauma
  2. sequela of aortic aneurysm
54
Q

Aortic Rupture

triad of clinical findings?

A
  1. hypotension
  2. pulsatile abd mass
  3. severe pain
55
Q

Aortic Rupture

what % of patients die before reaching the hospital? What % of patients survive surgery if caught in time?

A
  1. 50% of patients die before reaching hospital
  2. 50% of patients survive surgery
56
Q

Aortic Rupture

complications

A

abdominal compartment syndrome

57
Q

Aortic Rupture

imaging

4 options

A
  1. Chest Ct
  2. Transesophageal Echocardiogram
  3. Abdominal CT scan
  4. if hemodynamically unstable, get to OR without delay and do intraoperative imaging or exploration.
58
Q

Aortic Rupture

who can receive endovascular repair?

A

hemodynamically stable patients who have undergone CT imaging

59
Q

Aortic Rupture

which surgical repair option has lower mortality?

A

endovascular

60
Q

Aortic Dissection

define

A
  • spontanoeous tear of tinuca intima
  • blood dissects into the tunico media
  • repetitive torque during cardiac cycle (hypertension)
61
Q

Aortic Dissection

risk factors

4 categories (1, 2, 1, 2)

A
  1. HTN
  2. Connective Tissue Disorders (marfans, ehlers-danlos)
  3. pregnancy
  4. anatomic abnormalities (bicuspid aortic valve, coarctation of the aorta)
62
Q

Aortic Dissection

describe Type A Stanford Classification

A

involves ascending aorta and may progress to involve the arch and thoracoabdominal aorta

63
Q

Aortic Dissection

describe type B Stanford Classification

A

involves the descending thoracic or thoracoabdominal aorta distal to the subclavian artery without involvement of ascending aorta

64
Q

Aortic Dissection

describe DeBakey type I classification

A
  • involves the ascending aorta, arch, and descending thoracic aorta.
  • may progress to involve the abd aorta
65
Q

Aortic Dissection

describe DeBakey type II classification

A

confined to the ascending aorta

66
Q

Aortic Dissection

describe DeBakey type IIIa classification

A
  • involves descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery
67
Q

Aortic Dissection

describe DeBakey type IIIb classification

A

involves thoracic and abdominal aorta distal to left subclavian artery

68
Q

Aortic Dissection

Triad

A
  1. abrupt onset thoracic or abdominal pain with sharp, tearing, ripping character
  2. pulse and/or blood pressure variations between extremities
  3. mediastinal and aortic widening on CXR
69
Q

Aortic Dissection

other clinical findings beyond the triad

4 things

A
  1. pain radiates in respect to location and extension of dissection
  2. hypertension
  3. syncopal episodes
  4. Misc clinical findings based on location (hemiplegia, mesenteric ischemia, AKI, MI)
70
Q

Aortic Dissection

aortic root dissections may present with:

4

A
  1. diastolic murmur
  2. aortic regurgitation
  3. acute heart failure
  4. cardiac tamponade
71
Q

Aortic Dissection

what imaging to consider?

5

A
  1. ECG
  2. CXR
  3. CT of chest and abdomen
  4. MRI of chest and abdomen
  5. Transesophageal echo
72
Q

Aortic Dissection

how is electrocardiogram best used?

A

initial evaluaton of pts with chest pain

73
Q

Aortic Dissection

how is CT of chest and abdomen best used?

A

immediate diagnostic imaging of choice

74
Q

Aortic Dissection

management and disposition in terms of aggressive blood pressure control

A
  • reduce to 100-120 mmHg systolic
  • beta blockers are the first line management (labetalol)
75
Q

Peipheral Artery Disease

risk factors

9

A
  1. CAD
  2. increased age
  3. HTN
  4. dyslipidemia
  5. tobacco use
  6. male
  7. metabolic syndromes (DM)
  8. ED
  9. Family Hx
76
Q

Peipheral Artery Disease

clinical findings

6

A
  1. intermittent claudication (cramping pain in lower extremities, induced by activity, relieved with rest)
  2. cool skin temp
  3. pale skin color
  4. scant hair distribution
  5. weak distal pulses
  6. non-healing wounds
77
Q

Peipheral Artery Disease

complications

3

A
  1. chronic limb threatening ischemia
  2. non healing wounds
  3. gangrene
78
Q

Peipheral Artery Disease

Imaging

3

A
  1. Ankle Brachial Index
  2. CT angiogram or MR angiogram
  3. CT angiography (GOLD STANDARD)
79
Q

Peipheral Artery Disease

describe ankle brachial index (what it is and interpreting results)

A
  1. US assessment, ratio of systolic pressure in lower versus upper extermities
  2. normal: 1.0 to 1.4 ; PAD: < 0.9; severe disease: < 0.5
80
Q

Peipheral Artery Disease

management

A
  1. antiplatelet therapy
  2. high-intensity statin therapy
  3. risk factor modification
81
Q

Peipheral Artery Disease

what anti-platelets can be taken?

2

A
  1. clopidogrel
  2. aspirin
82
Q

Peipheral Artery Disease

risk factor modification strategies?

3

A
  1. smoking cessation
  2. tight glucose control
  3. blood pressure control
83
Q

Peipheral Artery Disease

Surgical Intervention

A

Endovascular Re-vascularitzation

84
Q

Peipheral Artery Disease

indications for endovascular revascularization

4

A
  • significant pain
  • disability
  • inadequate response to tx
  • critical limb ischemia
85
Q

Peipheral Artery Disease

Chronic Limb Threatening Ischemia clinical findings

A
  1. foot ischemic wounds
  2. ulceration and gangrene
  3. severe vascular insufficiency
  4. ischemic rest pain
86
Q

Peipheral Artery Disease

management of chronic limb threatening ischemia in diabetic patients with foot wounds

A
  1. refer for vascular evaluation
  2. operative incision and drainage with perioperative IV antibiotics
87
Q

Peipheral Artery Disease

management of chronic limb threatening ischemia with surgical repair

A
  • restore blood flow with bypass with vein to distal tibial and pedal arteries
88
Q

Acute Arterial Occlusion- Acute Limb Ischemia

describe thrombus

A
  • blood clot that develops as a result of a ruptured atherosclerotic plaque or stagnant blood flow from cardiac arrhythmia
  • occlusion of small, distal arteries
  • hx of PAD
89
Q

Acute Arterial Occlusion- Acute Limb Ischemia

describe embolus

A
  1. a blood clot arising from the vascular system that travels to a distal area, causing occlusion
  2. occlusion of larger arteries
  3. hx of cardiac event
90
Q

Acute Arterial Occlusion- Acute Limb Ischemia

Etiologies of Arterial Embolism

3

A
  1. atrial fibrillation
  2. valvular disease
  3. left ventricular clot formation from MI
91
Q

Acute Arterial Occlusion- Acute Limb Ischemia

etiology of acute thrombus

A

pre-existing PAD

92
Q

Acute Arterial Occlusion- Acute Limb Ischemia

Clinical findings

6

A
  1. pain
  2. pulselessness
  3. pallor
  4. paralysis
  5. paresthesia
  6. limb cool to touch
93
Q

Acute Arterial Occlusion- Acute Limb Ischemia

imaging

A
  1. arterial doppler US
  2. CT angiography
93
Q

Acute Arterial Occlusion- Acute Limb Ischemia

when to use CT angiography?

2 components

A
  1. delayed intervention
  2. reserved for viable ischemia
94
Q

Acute Arterial Occlusion- Acute Limb Ischemia

what are the 2 clinical interventions

A
  1. anti-coagulation
  2. endovascular revascularization
95
Q

Acute Arterial Occlusion- Acute Limb Ischemia

describe anti-coag as intervention

A
  1. unfractionated Heparin IV
  2. clot propagation prevention, but does not resolve occlusion
96
Q

Acute Arterial Occlusion- Acute Limb Ischemia

describe endovascular revascularization methods

2

A
  1. catheter directed thrombolysis
  2. thromboembolectomy
97
Q

Acute Arterial Occlusion- Acute Limb Ischemia

within how long must revascularization take place in immediately threatened disease?

A

3 hrs

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