Vascular Path Robbins Part 2 Flashcards Preview

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Flashcards in Vascular Path Robbins Part 2 Deck (18)
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localized abnormal dilation of a BV
-may be congenital or acquired


true aneurysm vs false aneurysm

-true- intact (but thinned) muscular wall
-false- defect thru the vessel wall or heart, communicating with an extravascular hematoma ("pulsating hematoma")


saccular vs fusiform aneurysms

-saccular- spherical
-fusiform- diffuse, circumferential dilations of a long vascular segment


aneurysm- caused by?

-defective vascular wall CT
-net degradation of vascular wall CT
-weakening of vascular wall by ischemia (atherosclerosis, HTN, tertiary syphilis)


defective vascular wall CT- causes

-Marfan syndrome (fibrill def)
-Loeys-Dietz syndrome- mutations in TGF-B R's- def syn of elastin and collagens I, III
-Ehlers-Danlos syndrome- def type III collagen syn
-vit C def- altered collagen cross-linking


net degradation of vascular wall CT- causes

-inflammation and assoc proteases
-matrix metalloprotease (MMP)- degrade extracellular matrix in aretrial wall
-dec expression of TIMPs (tissue inhibitors of MMP)


weakening of vascular wall by ischemia- causes

-loss of smooth m or syn of noncollagenous or nonelastic ECM
-inner media ischemia- atherosclerosis
-outer media ischemia- HTN (vaso vasorum narrowed)
-tertiary syphilis- obliterative endarteritis of vaso vasorum of thoracic aorta


aneurysm - loss of vascular wall elastic tissue or ineffective elastin syn- leads to final common result of diff conditions??

-cystic medial degeneration- with disorganized elastin filaments and increased ground substance (proteoglycans)


2 most important causes of aortic aneurysms

-atherosclerosis (abdominal aorta)
-HTN (thoracic aorta)


abdominal aortic aneurysm- due to? occurs where? more frequent in?

-usually below renal a's; often involve common iliac a's
-men, smokers, 6th decade of life


abdominal aortic aneurysm- characterized by? complications?

severe atherosclerosis of aorta, covered with mural thrombus
-pulsating mass in abdomen!
-rupture, hemorrhage
-occlusion of branching a's, downstream ischemia
-impingement on another structure


abdominal aortic aneurysm- rupture risk related to?

aneurysm size!
->5 cm- managed surgically! (11% risk)


3 AAA variants

-infl AAA (5-10%)- younger pts, back pain, elevated infl markers- localized immune response to aortic wall
-IgG4-related disease- high plasma levels of IgG4 and tissue fibrosis
-mycotic AAA- lesions infected by the lodging of circulating microorganisms in the wall


thoracic aortic aneurysm- caused by? clinical presentation?

-HTN or less commonly Marfan syndrome!
-impingement- lower resp tree, esophagus, recurrent laryngeal n's (cough)
-aortic valvular insuff
-pain- erosion of bone


aortic dissection- occurs when? occurs in who? primary risk factor? classic presentation?

blood enters a defect in the intima- travels within layers of aortic media
-HTN males (40-60); Marfan's syndrome, rarely in pregnancy
-severe chest pain, radiating to back b/w scapulae


major risk factor for aortic dissection

-medial hypertrophy of vasa vasorum with degenerative changes


aortic dissection pathogenesis, most occur where?

-blood enters aortic wall via an intimal tear- forms an intramural hematoma
-in HTN pts- have some degree of cystic medial degeneration
-most in ascending aorta


aortic dissection- type A and B

-A- more common, higher morbidity and mortality- adj to aortic root!- treat with antiHTN therapy, surgical repair (deBakey types 1 and II)
-B- distal not involving the ascending part (deBakey type III