Peripheral Vascular Disease

Front 1

Layers of arteries

Back 1

Tunica intima: Endothelial cells and subendothelial connective tissue

Tunica media: Smooth muscle cells in concentric layers with outer elastic membrane

Tunica adventitia: Connective tissue in wich nerve fibers and vasculature (vasa vasorum) runs

Front 2

Pathophysiological processes affecting vasculature

Back 2

(1) atherosclerosis
(2) aneurysm
(3) embolism
(4) thrombosis
(5) inflammation
(6) trauma
(7) vasospasm
(8) arteriovenous fistula

Front 3

Laplaces law

Back 3

Tension = pressure X radius

Front 4

Mechanisms whereby aneurysms cause symptoms

Back 4

(1) rupture with subsequent hemorrhage

(2) impingement on adjacent structures
(3) occlusion of a vessel by either direct pressure or mural thrombus formation

(4) embolism from mural thrombus

(5) Presentation as a pulsatile mass

Front 5

Embolism

Back 5

Clot or foreign body carried by blood to site distant from its point of origin

Front 6

Types of Emboli

Back 6

(1) Thromboemoblism - most commonly cardiac

(2) Atheroemboli - from proximal atherosclerotic plaques

(3) Septic emboli

(4) Malignant emboli

(5) Venous (paradoxical) emboli

(6) Foreign body emboli (e.g. Air)

(7) Fat embolism

Front 7

Thrombosis

Back 7

in situ formation of a blood clot within the
uninterrupted arterial vascular system

Front 8

Causes of arterial thrombosis

Back 8

(1) Atherosclerosis

(2) Vasculitis

(3) Trauma

Front 9

Risk factors of peripheral arterial disease

Back 9

Related to atherosclerosis

- Smoking

- HTN

- Hypercholesterolemia

- DM

Non-related to atherosclerosis

- IVDU

- Prior trauma/surgery

- History of PE

- History of phlebitis

- Autoimmune disease

- Prior coagulation abnormalities

-

Front 10

5p's of acute arterial occlusion

Back 10

Pain

Pallor

Pulselessness

Parasthesias

Paralysis

Front 11

Overview of management of acute arterial occlusion

Back 11

Front 12

Patterns of pain with chronic arterial insufficency

Back 12

(1) Intermittent activity related claudication

(2) Ischemic rest pain that improves with standing

Front 13

Buerger's sign

Back 13

Pallor with elevation of legs to 45 degrees that resolves to cyanosis then hyperemia with dangling

Front 14

ABI interpretation

Back 14

>1.3 Non compressible

0.9 - 1.3 Normal

<0.9 Abnormal

<0.5 Severe

Front 15

Differentiating emboli versus thrombus on acute PAD

Back 15

Front 16

Raynaud's triphasic colors

Back 16

Pallor (white)

Cyanosis (blue)

Rubor (red)

Front 17

Indications for emergency angiography

Back 17

(1) acute arterial embolus or thrombosis if the clinical diagnosis is uncertain

(2) consideration of emergency vascular bypass grafting

(3) characterization of vascular abnormality before emergency surgical correction

Front 18

Vascular graft complications

Back 18

Stenosis

Thrombosis

False Aneurysm

Infection

Front 19

Arterial Ulcers

Back 19

Vasculopath

Moderate to severe pain that increases with elevation/activity and decreased by dependency

Between toes/tips of toes
Over phalangeal heads
Around lateral malleolus
At sites subjected to trauma

Well demarcated, punched out, pale or white base

Front 20

Venous ulcers

Back 20

History of venous disease, obesity, advanced age

Mild to moderate pain that improves with elevation

On medial/lower calf and ankle

Rapidly progressive, with irregular borders, granulation, exudative, weeping

Front 21

Diabetic ulcer

Back 21

Diabetic/peripheral neuropathy

Little to no pain

Pressure sites, heel, plantar surface

Deep and penetrating, often with secondary damage due to infection

Front 22

Hypertensive ulcer

Back 22

Red, very painful, ischemic lower extremity ulcers

Front 23

Buerger’s Disease (Thromboangiitis Obliterans)

Back 23

idiopathic inflammatory occlusive disease primarily involving the medium-sized and small arteries of the hands and feet

Males 20 - 40 years, heavy smokers

Front 24

phlebitis migrans

Back 24

painful, tender, reddened, or dark nodules over a peripheral artery with either a reduced or an absent pulse

Front 25

Clinical criteria for Buerger's disease

Back 25

(1) a history of smoking

(2) onset before the age of 50

(3) infrapopliteal arterial occlusive lesions

(4) either upper limb involvement or phlebitis
migrans

(5) absence of atherosclerotic risk factors other than smoking

Front 26

Primary risk of central aneurysms (abdominal aorta, iliac, visceral)

Back 26

Rupture

Front 27

Primary risk of peripheral aneurysm

Back 27

Thombosis

Embolism

Front 28

Most common causes of peripheral aneurysms by location

Back 28

Lower extremity:

- atherosclerotic

Upper extremity aneurysms

- lower trauma

Visceral aneurysms

- abnormal hemodynamics
- atherosclerosis

- infections

Front 29

Clinical characteristics of infected aneurysms

Back 29

Front 30

Diagnostic criteria for Raynaud's disease

Back 30

(1) precipitated by cold or emotion

(2) symptoms are bilateral

(3) gangrene is absent/minimal and confined to the skin

(4) no disease or condition that could cause a secondary Raynaud’s phenomenon is present

(5) occurring for at least 2 years

Front 31

Rayaud's phenomenon

Back 31

Raynaud's occuring secondary to an autoimmune cause

Front 32

Overview of thoracic outlet syndrome

Back 32

Front 33

Physical Exam to elicit thoracic outlet syndrome

Back 33

Elevated arm stress test (EAST/Roos test)

Front 34

DDx of occluded indwelling catheter

Back 34

Front 35

Rosen's approach to an occluded catheter

Back 35

Front 36

Thoracic outlet syndrome

Back 36

Compression of the (1) brachial plexus, (2) subclavian artery, or (3) subclavian vein at the superior aperture of the thorax

Front 37

Indications for arteriography in thoracic outlet syndrome

Back 37

- obliteration of radial pulse on EAST

- Blood pressure differential of 20mm between limbs

- possible subclavian stenosis or aneurysm (supraclavicular bruit/pulsation)

- peripheral emboli in UE