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CSI- Winter > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

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

A

a low pressure system

capillaries

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2
Q

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

A

Aortoilliac

Femoral Popliteal, Infrapopliteal

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3
Q

Typical etiology is ___________

A

Atherosclerosis

Often the first sign of disease elsewhere (CAD)

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4
Q

Diabetes will show arterial occlusions in

A

distal lower extremities, esp. feet, diabetic foot wounds

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5
Q

Thromboembolic arterial occlusions will occur in

A

limbs

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6
Q

Epidemiology

A

White, Male, Age 50-60, Smokers

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7
Q

S/S (5 Ps of arterial occlusion)

A
  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
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8
Q

Other S/S of arterial occlusion

A
  • Muscle atrophy
  • Erectile Dysfunction
  • Loss of hair of distal extremities
  • Skin Changes: Hyperemia, Cyanotic, Dusky Appearing, Cool to Touch
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9
Q

Use Ankle-Brachial Index (ABI) to diagnose

A

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

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10
Q

ABI ranges

A

Normal 1.0-1.2

Reduced Blood Flow ABI

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11
Q

Critical limb ischemia will show

2 things

A

Elevated Myglobin

Metabolic Acidosis

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12
Q

Imagine for arterial occlusion

A

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

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13
Q

Conservative treatment for arterial occlusion

A

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

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14
Q

Endovascular techniques for arterial occlusion

A

Angioplasty and Stenting

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15
Q

Surgical techniques for arterial occlusion

A

Endarterctomy, Bypass Grafting

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16
Q

Treatment for Critical Limb Ischemia

A
  • Heparin
  • Catheter Directed tPA
  • Thrombectomy

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

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17
Q

Aneurysm

A

Pathologic dilation of a blood vessel

Aortic Aneurysms
Berry Aneurysms
Peripheral Aneurysms
-diseases associated with these

18
Q

Congenital causes of aneurysms

A

Marfans Syndrome: defective elastin gene

Ehler-Danlos Syndrome: defective collagen gene

19
Q

Factors that can cause aneurysms

A 
Age
HTN
Smoking, pollution?
Inflammation
Atherosclerosis
Syphilis
Trauma
20
Q

Abdominal Aortic Aneurysm (AAA) 5 facts

A
  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
Q

S/S of AAA

A
  • 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
Q

When AAA ruptures

A
  1. Sudden onset severe pain with blood in the retroperitoneum
  2. Palpable mass can be present
  3. Hypotension
23
Q

Imaging for AAA

A
  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
Q

Conservative treatment/management for AAA

A
  • Smoking Cessation
  • Manage HTN
  • Serial Imaging: Every 2 yrs
25
Q

Elective Surgical Repair if size of AAA is

A

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

26
Q

Absolute Indication for Surgery Consult when

A
  • 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
Q

Grey Turner Sign

A

bruising on flank/side of body

28
Q

Cullen’s Sign

A

bruising around umbilicus

29
Q

Thoracic Aortic Aneurysm S/S

(

A
  • Severe persistent substernal chest pain
  • Radiation to the back/neck
  • Usually Hypertensive
  • Dyspnea, stridor, dysphagia, hoarseness
  • UE Edema
30
Q

Imaging for Thoracic Aortic Aneurysm

A
  1. Chest CT Modality of Choice
  2. Chest Xray- Widened mediastinum
  3. Echocardiography
31
Q

Treatment for Thoracic Aortic Aneurysm

A
  1. Monitoring (Stable Descending Aortic Aneurysm 6cm in diameter
32
Q

Aortic Dissections (3 types)

A

DeBakey I, II, III (pictures)

33
Q

Conditions associated with increased risk of aortic dissection

A
  1. Pregnancy
  2. Bicuspid aortic valve
  3. Coarctation of the Aorta
34
Q

S/S of Aortic Dissection

A
  • Severe persistent substernal chest pain
  • Radiation to the back/neck
  • Usually Hypertensive
  • Dyspnea, stridor, dysphagia, hoarseness
  • UE Edema
  • Diastolic Murmur
  • Intestinal ischemia
  • Diminished /unequal peripheral pulses
  • Acute Heart Failure
  • Pericardial Tamponade
35
Q

Imaging used for Aortic Dissection

A

CT Chest and abdomen

36
Q

Medical treatment for Aortic Dissection

A

Aggressive HTN management
Beta blockers, Nitroprusside
Morphine for pain

37
Q

Surgical Treatment for which Aortic Dissections?

A
  • all Type A

* Type B affecting left subclavian artery

38
Q

Venous insufficiency may be associated with

A 
Obesity,
Previous leg trauma,
Previous DVT
Varicose veins
Neoplastic obstruction
AV fistula (congenital or acquired)
39
Q

Pathology of venous insufficiency

A
  • Valve leaflets do not close
  • Increased Hydrostatic Pressure
  • Causes characteristic Skin changes
40
Q

S/S of venous insufficiency

A
  1. Progressive Pitting Edema
  2. Secondary skin changes:
    Edema
    Fibrosis
    Hyperpigmentation-Hemosiderin deposition
    Thickening of the subcutaneous tissue
    Pruritis
    Ulceration
    Impaired wound healing
    Skin will have lack of hair, not warm, “dusty” purple/bruised appearance, not red.
41
Q

treatment for venous insufficiency

A
  1. Fitted Graduated Compression Stockings
  2. Avoidance of long periods of time sitting/standing
  3. Intermittent elevation

CSI- Winter (44 decks)

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