Diseases of the Peripheral Vasculature

Question 1

What is a ‘true aneurysm’?

Answer 1

• caused by degenerative changes in the aortic wall
• medial degeneration is associated with ascending thoracic aortic aneurysms
• atherosclerosis is commonly found in descending thoracic and abdominal aortic aneurysms

Question 2

What is a ‘false aneurysm’ (pseudoaneurysm)?

Answer 2

Represents a hole in the arterial intima and media contained by a layer of adventitia or perivascular clot

Question 3

What are the symptoms of aortic aneurysm?

Answer 3

• relate to compression of adjacent structures (back pain, dysphagia, respiratory symptoms)
• blood leakage, with the most severe consequence being aneurysm rupture

Question 4

What is aortic dissection?

Answer 4

This results from a tear in the intima that allows blood to enter into the medial layer, often in the setting of advanced age, hypertension, or cystic medial degeneration.

Question 5

What is the difference between a Type A (proximal), and a Type B aortic dissection?

Answer 5

• Type A: involves the ascending aorta, is life threatening, and requires surgical repair
• Type B: confined to the descending aorta and often managed by pharmalogic therapy alone.

Question 6

What is peripheral artery disease (PAD)?

Answer 6

A common atherosclerotic disease of large and medium sized arteries resulting in claudication of the limbs.

Question 7

How is peripheral artery disease (PAD) treated?

Answer 7

• risk factor modification
• exercise
• antiplatelet agents
• cilostazol (a selective phosphodiesterase inhibitor)

Question 8

What is an arterial embolism?

Answer 8

Arises from thrombus within the heart, from proximal arterial sites, or paradoxically from the systemic veins in the presence of an intracardiac shunt (e.g. atrial septal defect or patent foramen ovale).

Question 9

What are therapeutic options for acute arterial occlusion?

Answer 9

• anticoagulation
• thrombolysis
• surgical or endovascular interventions

Question 10

What are vasculitic syndromes?

Answer 10

Inflammatory diseases of blood vessels that impair arterial flow and result in localized and systemic symptoms.
Such syndromes are distinguished from one another by the pattern of vessel involvement and morphologic findings.

Question 11

What is Raynaud phenomenon?

Answer 11

An episodic vasospasm of arteries that supply the digits of the upper and lower extremities.

Question 12

What are varicose veins?

Answer 12

Dilated tortuous vessels that may present cosmetic problems, discomfort, become thrombosed, or lead to venous insufficiency.