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
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