Chapter 117 - Upper extremity arterial disease - introduction

Question 1

Upper extremity as a percentage of all extremity ischemia

Answer 1

5%

Question 2

What percentage of diabetics will have abnormal doppler of upper extremity

Answer 2

2-3%

Question 3

Raynaud’s syndrome prevalence in male, female and north vs south

Answer 3

Female: North 9%; South 4% Male: North 6%; South 3%

Question 4

Raynaud’s syndrome is further divided

Answer 4

Primary Raynaud’s disease = idiopathic Secondary Raynaud’s phenomenon = identifiable pathology or associated disease; more severe

Question 5

Most common types of secondary raynaud’s phenomenon

Answer 5

1) Scleroderma 2) Mixed connective tissue disease 3) SLE 4) RA

Question 6

Causes of arterial vasospasm

Answer 6

1) Ergotism 2) Vinyl chloride 3) Idiopathic Raynauds

Question 7

Vasoactive Raynauds definition

Answer 7

1) Normal pressure at baseline 2) Hypoperfusion with triggers (Cold, stress, caffeine)

Question 8

Obstructive Raynaud’s definition

Answer 8

1) Low resting pressure with symptoms 2) Triggers worsen symptoms

Question 9

Scleroderma definition

Answer 9

1) Generalized disorder of connective tissue microvasculature in small arteries

Question 10

Scleroderma F:M ratio

Answer 10

3:1 F:M

Question 11

Prevalence of scleroderma in US

Answer 11

10 in 1 million

Question 12

Scleroderma on organ level

Answer 12

Severe scarring and vessel occlusion in skin, GI, kidney, lung, heart

Question 13

Scleroderma genetic

Answer 13

Anti-centromere Anti-topoisomerase (Anti-scl-70)

Question 14

Percentage of scleroderma that get raynauds phenomenon

Answer 14

80-90%

Question 15

SLE mechanism

Answer 15

Immune complex deposition

Question 16

SLE symptoms

Answer 16

1) Fever 2) arthralgia 3) Skin rash 4) Raynaud 5) nephritis

Question 17

Percentage of SLE with Raynaud’s phenomenon

Answer 17

80%

Question 18

Mixed connective tissue disease mechanism

Answer 18

Antibody to nuclear antigen Overlap of other connective tissue diseases

Question 19

Buerger’s also known as

Answer 19

Thromboangiitis obliterans

Question 20

Buerger’s definition

Answer 20

Segmental thrombotic occlusion of small and medium arteries

Question 21

Buergers affect this population

Answer 21

young male smokers

Question 22

Symptoms of Buergers

Answer 22

migratory thrombophlebitis and Raynaud’s syndrome

Question 23

Diagnostic criteria for Buerger’s

Answer 23

1) Age < 45 2) smoking 3) exclusion of others 4) normal artery proximal to popliteal or brachial 5) digital occlusion

Question 24

Hand-arm vibration syndrome

Answer 24

1) Raynaud’s syndrome after long term vibrating tool use 2) vasoactive becomes obstructive with time

Question 25

Fibromuscular dysplasia in upper extremity

Answer 25

Rare May predispose hypothenar hammer syndrome

Question 26

Hypersensitivity angiitis key points

Answer 26

1) Acute digital ischemia with ulceration without underlying abnormalities 2) Resolves and has a benign course 3) Immune-mediated arterial wall injury

Question 27

Frostbite in UE ischemia

Answer 27

Vasospastic but can become occlusive if severe

Question 28

Large vessel arteriopathies

Answer 28

1) Atherosclerotic 2) aneurysmal 3) Takayasu 4) GCA 5) Dialysis access steal 6) iatrogenic

Question 29

Rate of art lines resulting in pathologies

Answer 29

Radial: 3-10% Brachial: 1-5%

Question 30

AVF steal when brachial inflow used

Answer 30

5-10%

Question 31

Acute ischemia and rate of limb loss

Answer 31

Axillary occlusion: 10% limb loss Brachial occlusion distal to deep artery branch: 5% digital gangrene

Question 32

Pressure difference to indicate significant arm pressure gradient

Answer 32

20 mmHg

Question 33

Medical treatment in vasoactive spastic

Answer 33

1) conservative avoid trigger 2) calcium channel blocker Nifedipine 3) Losartan 4) Fluoxetine SSUI 5) Prazosin 6) Sidenafil 7) Reserpone 8) Cilostazol 9) Captopril 10) Bosertan (Endothelin receptor blocker) in Scleroderma

Question 34

Rate of obstructive disease that do not tolerate nifedipine

Answer 34

20-30%

Question 35

Type of Raynaud with worst prognosis

Answer 35

Obstructive with underlying cause

Question 36

Chance of ulcer occurrence/recurrence

Answer 36

If no ulcer at initial, unlikely to ever If ulcer at initial, 50% recurrence

Question 37

Thoracic sympathectomy for UE ischemia

Answer 37

Works in vasospasm but recurrence in 3-6 months No effect in obstructive disease: already maximally dilated

Question 38

Arterial bypass in UE patency and limb salvage

Answer 38

Patency 83% 3 years Limb salvage 100% 3 years

Question 39

Causes of hand ischemia

Answer 39

Question 40

Arterial disease and artery affected

Answer 40

Question 41

Most common laboratory tests for diagnostic evaluation of UE ischemia

Answer 41