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Flashcards in Vascular Disease Deck (41)
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1

Arteries are a high pressure system. Venous return follows arterial supply as _________. Gas exchange occurs in the __________.

a low pressure system
capillaries

2

Arterial Occlusion-
Can occur centrally: _________
Generally start peripherally: ___________

Aortoilliac
Femoral Popliteal, Infrapopliteal

3

Typical etiology is ___________

Atherosclerosis
Often the first sign of disease elsewhere (CAD)

4

Diabetes will show arterial occlusions in

distal lower extremities, esp. feet, diabetic foot wounds

5

Thromboembolic arterial occlusions will occur in

limbs

6

Epidemiology

White, Male, Age 50-60, Smokers

7

S/S (5 Ps of arterial occlusion)

1. Pain (Claudication: Severe Cramping associated with exertion; Can be variable/ “intermittent”; Inability of blood flow to tissue demands)
2. Pallor
3. Pulselessness (Weak or Absent distal to the occlusion)
4. Paresthesias
5. Paralysis

8

Other S/S of arterial occlusion

-Muscle atrophy
-Erectile Dysfunction
-Loss of hair of distal extremities
-Skin Changes: Hyperemia, Cyanotic, Dusky Appearing, Cool to Touch

9

Use Ankle-Brachial Index (ABI) to diagnose

The ratio of systolic blood pressure detected by doppler examination at the ankle compared to the brachial artery

10

ABI ranges

Normal 1.0-1.2
Reduced Blood Flow ABI

11

Critical limb ischemia will show
(2 things)

Elevated Myglobin
Metabolic Acidosis

12

Imagine for arterial occlusion

Angiography with CT or MR; mainly for Intervention to Identify affected vessels

13

Conservative treatment for arterial occlusion

Exercise, weight loss, smoking cessation, Cilostazol (PDEi), Antiplatelet agents (ASA, Clopidogrel)

14

Endovascular techniques for arterial occlusion

Angioplasty and Stenting

15

Surgical techniques for arterial occlusion

Endarterctomy, Bypass Grafting

16

Treatment for Critical Limb Ischemia

-Heparin
-Catheter Directed tPA
-Thrombectomy

*Complication may be compartment syndrome --> to treat do fasciotomy

17

Aneurysm

Pathologic dilation of a blood vessel

Aortic Aneurysms
Berry Aneurysms
Peripheral Aneurysms
-diseases associated with these

18

Congenital causes of aneurysms

Marfans Syndrome: defective elastin gene
Ehler-Danlos Syndrome: defective collagen gene

19

Factors that can cause aneurysms

Age
HTN
Smoking, pollution?
Inflammation
Atherosclerosis
Syphilis
Trauma

20

Abdominal Aortic Aneurysm (AAA) 5 facts

1. Present when Aorta diameter >3cm
2. Increase risk of rupture >5cm
3. Found in 2% of men over age 55
4. 90% originate below renal arteries
5. 4:1 Male predominance

21

S/S of AAA

-80% of 5cm infrarenal AAA are palpable
-Usually found incidentally on CT or U/S
*Pain: Mild-sever abdominal discomfort, Often radiate to the lower back, Intermittent or constant, Exacerbated with abdominal pressure

22

When AAA ruptures

1. Sudden onset severe pain with blood in the retroperitoneum
2. Palpable mass can be present
3. Hypotension

23

Imaging for AAA

1. **Abdominal ultrasound is #1**
Screening test; recommended in Men 65-74yrs with smoking history (not Women)

2. CT abdomen
Useful to assess for size and location, Planning for intervention,
Monitor Progression

24

Conservative treatment/management for AAA

-Smoking Cessation
-Manage HTN
-Serial Imaging: Every 2 yrs

25

Elective Surgical Repair if size of AAA is

>5.5cm diameter or >0.5cm increase in diameter in 6 months

26

Absolute Indication for Surgery Consult when

-Signs suggestive of Rupture or impending rupture
-Acute onset severe abdominal pain with radiation to the back
-Hypotension
-Cullen Sign, Grey Turner’s Sign-retroperitoneal hemorrhage

27

Grey Turner Sign

bruising on flank/side of body

28

Cullen's Sign

bruising around umbilicus

29

Thoracic Aortic Aneurysm S/S
(

-Severe persistent substernal chest pain
-Radiation to the back/neck
-Usually Hypertensive
-Dyspnea, stridor, dysphagia, hoarseness
-UE Edema

30

Imaging for Thoracic Aortic Aneurysm

1. *Chest CT* Modality of Choice
2. Chest Xray- Widened mediastinum
3. Echocardiography