Vascular Disease Flashcards Preview

CSI- Winter > Vascular Disease > Flashcards

Flashcards in Vascular Disease Deck (41)
Loading 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
2
Q
Arterial Occlusion-
Can occur centrally: _________
Generally start peripherally: ___________
A
Aortoilliac
Femoral Popliteal, Infrapopliteal
3
Q
Typical etiology is ___________
A
Atherosclerosis
Often the first sign of disease elsewhere (CAD)
4
Q
Diabetes will show arterial occlusions in
A
distal lower extremities, esp. feet, diabetic foot wounds
5
Q
Thromboembolic arterial occlusions will occur in
A
limbs
6
Q
Epidemiology
A
White, Male, Age 50-60, Smokers
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
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
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
10
Q
ABI ranges
A
Normal 1.0-1.2
Reduced Blood Flow ABI
11
Q
Critical limb ischemia will show
(2 things)
A
Elevated Myglobin
Metabolic Acidosis
12
Q
Imagine for arterial occlusion
A
Angiography with CT or MR; mainly for Intervention to Identify affected vessels
13
Q
Conservative treatment for arterial occlusion
A
Exercise, weight loss, smoking cessation, Cilostazol (PDEi), Antiplatelet agents (ASA, Clopidogrel)
14
Q
Endovascular techniques for arterial occlusion
A
Angioplasty and Stenting
15
Q
Surgical techniques for arterial occlusion
A
Endarterctomy, Bypass Grafting
16
Q
Treatment for Critical Limb Ischemia
A
-Heparin
-Catheter Directed tPA
-Thrombectomy

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