70% of AAA patients are ______, then present with sudden death.
asymptomatic
What is the greatest risk factor for PAD?
diabetes (4-fold)
What are the 4 major risk factors for AAA?
–Age –Gender –Smoking –Family history
Thrombophilia caused by any alteration in coagulation balance that:
• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition
How do aortic dissection pts typically present?
severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved
AAA denoted by diameter of _____ or ____.
> 3.0 cm; 50% increase in size relative to proximal normal segment
What are the 4 major risk factors for AAA?
–Age
–Gender
–Smoking
–Family history
At what aneurism size does the 5 year rupture rate exceed 1 in 4?
5 cm diameter
What are the signs of PAD?
- Decreased or absent pulses
- Bruits (abdominal, femoral)
- Muscle atrophy
- In severe PAD (critical leg ischemia)
– Pallor of feet with elevation
– Dependent rubor
What are the risk factors for aortic dissection?
- HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
Thrombophilia caused by any alteration in coagulation balance that:
• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition
How will you treat PAD with antithrombotic medication?
- aspirin/clopidogrel
What is aortic dissection?
when the vessel loses its integrity and essentially unravels
How are aortic dissections treated with meds?
- control heart rate (beta blockers) 2. control BP (nitro, ACEI, Ca++ channel blockers) 3. control pain (narcs)
What are the mechanisms of thrombophilia?
- increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition
What are the signs of PAD?
1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor
How do aortic dissection pts typically present?
severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved
_____% of AAA patients are asymptomatic, then present with sudden death.
70
Name 2 manifestations of venous thromboembolic disease.
- PE 2. DVT
PAD has a _____ increased risk of CV death.
6-fold
What are the signs of PAD?
1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor
30% of pts present with _____, then die.
abdominal discomfort or severe pain radiating to the back
DX? • 68 yr old male in for routine exam • H/O revascularization for angina in 2009 • In 2011 developed symptoms of left calf cramping on walking 1 block, relieved by rest • Risk factors: 50 pack years smoking, LDL 135, and diabetes • Physical exam: – Right carotid: artery bruit – Left leg: absent femoral and pedal pulses – Right leg: normal femoral and pedal pulses
L leg claudication, probably at the level of the iliac artery
What are the risk factors for thrombophilia?
- severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
How are AAAs repaired?
endovascular infrarenal aortic repair
What are the risk factors for aortic dissection?
- HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
What are Ischemic rest pain/ischemic ulcers?
Pain in the distal foot or heel, worsened by leg elevation and improved by dependency; painful ulcers
Name 2 manifestations of venous thromboembolic disease.
- PE 2. DVT
What are the risk factors for thrombophilia?
- severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
What are the mechanisms of aortic dissection?
- disruption of the intima (tear) 2. rupture of the vasa vasorum
What arteries are most at risk of atherothrombosis?
- aorta 2. iliacs 3. femoral/superficial femoral 4. popliteal 5. tibial
How do aortic dissection pts typically present?
severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the artery
What is the mortality rate of aortic dissection at 2 weeks? 3 mos?
2 weeks = 75% dead 3 mos = 90% dead
Dx? • Decreased or absent pulses • Bruits (abdominal, femoral) • Muscle atrophy • In severe PAD (critical leg ischemia) – Pallor of feet with elevation – Dependent rubor
PAD
What are the mechanisms of thrombophilia?
- increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition
DX? • 25 year old female medical student • Flies coach to Europe • 24 hours after arrival has tender, swollen right calf, pain on standing • Duplex ultrasound reveals thrombosis of popliteal, superficial femoral and iliac veins in right leg • Started on LMWH heparin in hospital, then 6 months warfarin • 2 years post event notices chronically swollen right calf that limits her activities
post-thrombotic syndrome (had destroyed all the valves in the affected area)
DX? • 25 year old female medical student • Flies coach to Europe • 24 hours after arrival has tender, swollen right calf, pain on standing • Duplex ultrasound reveals thrombosis of popliteal, superficial femoral and iliac veins in right leg • Started on LMWH heparin in hospital, then 6 months warfarin • 2 years post event notices chronically swollen right calf that limits her activities
post-thrombotic syndrome (had destroyed all the valves in the affected area)
30% of AAA pts present with _____, then die.
abdominal discomfort or severe pain radiating to the back
What are the signs of PAD?
1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor
How will you treat PAD with antithrombotic medication?
aspirin/clopidogrel
____% of AAA pts present with abdominal discomfort or severe pain radiating to the back, then die
30
At what ankle-branchial index value is PAD?
Ratio
What are the 4 overall mechanisms of aneurism formation?
- weakened aortic wall (decreased collagen/elastin) 2. inflammation (B and T lymphs, macs, cytokines, autoantigens) 3. proteolytic enzymes (increased MMP, tPA, decreased TIMPs) 4. biomechanical stress (elastin dist, turbulent blood flow, HTN, mural thrombus)
What are the 4 overall mechanisms of aneurism formation?
- weakened aortic wall (decreased collagen/elastin) 2. inflammation (B and T lymphs, macs, cytokines, autoantigens) 3. proteolytic enzymes (increased MMP, tPA, decreased TIMPs) 4. biomechanical stress (elastin dist, turbulent blood flow, mural thrombus)
What is the ankle-brachial index?
Ankle SBP/Arm SBP = ABI Ratio
What is the ankle-brachial index?
Ankle SBP/Arm SBP = ABI Ratio
At what aneurism size does the 5 year rupture rate exceed 1 in 4?
5 cm diameter
