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203 Cards in this Set
- Front
- Back
___________ is usually consulted in order to establish a dx and to recommend or carry out appropriate _____ |
- vascular surgeon
- tx |
|
What are the 3 main goals of vascular intervention?
|
- Re-establish blood flow
- Repair dilated/damaged vessels - Bypass occluded vessels |
|
Re-establishing blood flow through a vessel due to ____________ |
stenosis or vessel blocked my thromboembolism
|
|
What is used to bypass an occluded vessel?
|
- Native vein (usually vein but artery if necessary)
- Synthetic materials (Dacron/PTFE or Gortex) |
|
What are the two types of vascular intervention?
|
- vascular surgery
- Interventional Radiographic Procedures |
|
Vascular surgery is aided by what 3 things?
|
- angiography
- vascular technologists - knowledge of anatomical location of human vasculature |
|
How do vascular techs help aid in vascular surgery?
|
- US images
- Spectral Doppler waveforms - Physiologic test results |
|
What is the primary interventional radiographic procedure? |
- Endovascular procedures
- cardiologists, vascular surgeons, & interventional radiologists |
|
T or F:
In Interventional radiographic procedures, angiography and fluoroscopy are used as aids but not vascular techs |
FALSE:
Vascular techs ARE also an aid |
|
Candidates for vascular intervention must be carefully assessed: |
1. exams
2. vascular & angiographic 3. - vascular or organ-system diseases - best procedure |
|
What are the 4 factors that should be considered prior to decision? |
1. success rates
2. Risk 3. Cost 4. of failure |
|
Risk involves weight the degree of ______________ and _____________ of the underlying disease (_______), with the best medical tx against the risk (__________), & ____________ of various interventional options
|
- disability
- natural course - morbidity - mortality - success rates |
|
Decisions for pt candidates are based on a combo of what 3 things?
1. How ______________ 2. ________________ consultation 3. Available ______________ |
1. Ea hospital/clinic lists its own requirements (protocol) for vascular interventions
2. physician/pt 3. choices & final outcome |
|
How does a hospital/clinic decide what its requirements (protocol) are for vascular interventions? |
Sensitivity
|
|
Endovascular radiographic procedures are those procedures where ________ are placed w/in the vessels to allow ________________ |
- catheters
- interventional techniques |
|
PTA = ___________________
Involves: _____________ & ___________ of vessel plaque is ___________ w/ _____________ |
- Percutaneous transluminal angioplasty
- dilation & recanalization - penetrated w/catheter tip |
|
T or F:
PTA is not considered a surgery |
FALSE:
Originally it was considered non-surgical, but NOW considered endovascular surgery |
|
Balloon Angioplasty (PTA):
1. A double lumen balloon catheter expands to ________ 2. Employs a __________ used for balloon 3. A balloon catheter is also used to ___________ in arteries, veins & grafts. This is known as _______ |
1. predetermined diameter
2. flexible material 3. - remove embolized thrombus - thromboembolectomy |
|
What are two flexible materials that may be used for the balloon?
|
- Polyethylene
- Polyurethane |
|
Balloon angioplasty uses different ___________ and expandable ____________. |
- lengths
- diameters - size |
|
Balloon should approximate the diameter of the ________ and length of the _____________
Balloon should be 10-20% less than ____________ |
- vessel
- lesion - the adjacent normal vessel diameter |
|
________________ is a big issue for stent placement
|
intimal hyperplasia
|
|
T or F: |
FALSE:
Balloon is CHEAPER than a stent |
|
Balloon dilation: |
1. - controlled injury
- fx - split - compressed 2. tunica media is stretched 3. - attachment - media |
|
T or F:
Embolism occurs often in balloon angioplasty |
FALSE:
Usually no embolism occurs |
|
Plaque remains attached to the media but a ______________ may be deployed w/ ____________
The media & adventitia undergo further _________ over a period of time as they respond to _____________ |
- net
- carotid balloon angioplasty - dilation - hemodynamic demands |
|
T or F:
Rarely will do a balloon angioplasty and end up putting a stent in also |
FALSE:
Often will do the PTA and put a stent in |
|
How well is soft plaque tx w/balloon angioplasty?
Soft plaque is usually _____________ w/angioplasty |
It responds the best
- readily treated |
|
What doesn't respond well to PTA?
|
- densely calcified plaques
- Elongated plaques - Lesions containing LG amounts of thrombus (clot) |
|
T or F:
PTA is considered technically successful if there is < 35% residual stenosis after the procedure is completed |
FALSE:
LESS than 30% |
|
Where are 4 possible locations for complications with angioplasty?
|
- Arterial entry site
- Angioplasty site - Systemically - Distal to angioplasty site |
|
Commonly there is a ___________ at the puncture site |
- hematoma formation
- thrombus formation - pseudoaneurysm - AV fistula |
|
1. Acute occlusion (1-7%) is generally caused by what 3 things?
2. Poss __________ from perforation of artery 3. Both complications are ______________ because of __________ |
1. - thrombosis
- intimal tear - local artery spasm 2. - hemorrhage 3. rare--high quality |
|
Angioplasty at a bifurcation can caused fracturing of plaque into ________________
How is this problem reduced? |
- branch artery
- By placing two balloons--one in ea branch of the bifurcation |
|
What is the term for placing two balloons--one in each branch of the bifurcation? |
"kissing balloons"
* Because they actually touch when inflated |
|
Distal to angioplasty site:
Poss ____________ of ___________ Poss balloon fragment embolization from ________ |
- embolization
- fresh thrombus - rupture |
|
What are 3 systemic complications w/angioplasty?
|
- MI: partial stroke
- CVA: Completed stroke - septicemia w/diabetes pts |
|
Septicemia is the presence of ___________ in the blood |
pathogenic bacteria
|
|
T or F:
Diabetics have a low risk of septicemia after angioplasty procedure |
FALSE:
Diabetics have a decreased overall immunity & run a HIGHER risk of septicemia if any pathogens are introduced via the angioplasty procedure |
|
Intravascular stents are very popular but _________
These are metallic devices designed to preserve ________ They are utilized when vascular ___________ from ___________ or inadequate PTA results |
- expensive
- arterial or venous lumen - narrowing - external compression |
|
What are the 3 types of stents?
|
- Balloon expandable
- Self expanding - Nitonol stents |
|
Balloon expandable the stent metal conforms w/ ________
The stent is _____________ around the deflated balloon prior to placement and then ____________ into place when the balloon is ___________ |
- pressure
- collapsed - expanded - inflated |
|
May put a balloon in first and then place the stent.
Why would you do this? |
Because a stent alone is not strong enough to fx the plaque
|
|
In a _____________ the _____________ allows expansion when stent is pushed out of a retaining tube sheath |
self expanding stent
- spring action - It is difficult to length match w/the lesion |
|
Nitonol stents are ________ while cool |
- collapsed
- original sz - warmed - blood temperature |
|
Intravascular Ultra Sound is when an US tipped ___________ can be used to image the vessel from _____________
|
- catheter
- inside and outward |
|
IVUS can be used to evaluate success of a _________
and of a ____________. Could also see an intimal ___________ |
- balloon angioplasty
- stent placement - tear |
|
What is a negative about IVUS?
|
Can't sterilize the probe---have to throw it away---expensive
|
|
What are the 2 poss surgical interventions?
|
- Profundaplasty
- Endarterectomy |
|
_____________ is the surgical procedure of profunda femoral artery to restore function as ______________ to _______________
|
- Profundaplasty
- collateral - popliteal or calf |
|
When is profundaplasty used?
May be only procedure available if ______________ is not feasible |
When prox profunda occluded along w/SFA
- distal bypass |
|
T or F: |
FALSE:
May prevent AK (above knee) amp |
|
Which intervention involves direct removal of occlusive arterial lesions?
What are the 5 specific techniques? Which is most common? |
Endarterectomy
- Open (most common) - Semi-closed - Extraction - Eversion - Selective |
|
Open involves: |
- arteriotomy
- lesion - carotid *especially if plaque is hard |
|
For a semi-closed endarterectomy: |
- arteriotomies
- prox & distal - distal end - atheroma |
|
In semi-closed, the lesion is detached and removed in retrograde manner w/ ___________
What types of lesions is this used on? |
- loop stripper
- Thinner, softer, less calcified lesions |
|
T or F:
In extraction, retrograde and antegrade removal of lesion is done through an arteriotomy at the proximal and distal end |
FALSE:
Extraction: Retrograde/antegrade removal of lesion through SINGLE arteriotomy |
|
Extraction: |
not seen
- dural elevator - dural elevator -media - plaque |
|
T or F;
Extraction is used for thinner, softer, less calcified plaques |
FALSE:
Used on THICKER, HARDER, MORE calcified lesions |
|
Eversion requires ________ of artery beyond site of disease or can be used in open endarterectomy w/a ____________
Vessel is ________ or ___________ to separate the vessel wall from the ___________ Once the atheroma is removed the vessel is __________ back into position and sewn together |
- distal transection
- longitudinal arteriotomy - turned - peeled back - atheroma - folded |
|
T or F:
A selective endarterectomy is a modification of the extraction procedure |
FALSE:
Selective is a modification of the SEMI-CLOSED |
|
Selective is used to remove _________ in arterial segments or branch.
_________ removal thru distal longitudinal arteriotomy w/a ____________ Performed w/in ________ segment |
- discontinuous lesions
- retrograde - loop stripper - diseased arterial |
|
What are the 2 surgical assessment aides?
|
- Intraoperative arteriography (uses contrast) |
|
T or F:
Intraoperative arteriography & duplex are assessment tools used pre vascular surgery |
FALSE:
Used POST vascular surgery |
|
A true aneurysm is a _____________ of ________ of the arterial wall.
Two types are: _____________ |
- dilation
- all layers - Fusiform & saccular |
|
A pseudoanuerysm ________ contain arterial wall layers but rather is a ________________ |
- doesn't
- pulsating hematoma (active lumen=active blood Q) - communicating channel |
|
Pseudoaneurysms are considered a ________ as well as a ____________
What are the 3 etiologies? |
- peripheral arterial mass
- pulsating hematoma - Previous trauma - Infection - Intervention |
|
T or F:
Pseudoaneurysms are most commonly found at the brachial artery but also at the CFA |
FALSE:
Most commonly found at CFA but also at brachial artery |
|
Pseduoaneurysms are located close to _________ into arterial lumen.
They are connected to the lumen by __________. Arterial sticks above _________increase change of pseudoaneurysms Pseudo's may result due to poor _____________ following _________________ |
- entry site
- a channel or neck - inguinal ligament - compression - removal of catheter |
|
What are the 3 Risk Factors for pseudoaneurysms?
1. _________________ due to body habitus 2. Use of ___________ 3. Use of ____________ |
- Deep lying arteries
- anticoagulants - Larger diameter catheter (1 French=.33mm) *Increase diameter= increase risk |
|
What are the 3 duplex findings of a pseudoaneurysm?
1. ______________ surrounded by a fibrous wall 2. ____________ seen layered w/in pseudo walls 3. ____________ seen w/color Q |
- Blood in the hematoma
- Thrombus - Swirling low velocities |
|
In spectral analysis of pseudoaneurysm:
Neck is identified by a __________ of the Doppler waveform. During systole, high velocity is detected flowing out of ____________ into the ___________ During diastole flow _____________ to the native artery |
- to and fro pattern
- native artery - contained rupture - returns back |
|
You will need to obtain measurements in ____________ |
- aneurysm & neck
- "pepsi sign" |
|
What are 5 complications w/pseudoaneurysms?
1. Rupture w/___________ 2. Arterial ____________ 3. _____________ of the native artery 4. Persistent _______ 5. Persistent ____________ |
1. severe hemorrhaging
2. Thromboembolization 3. Extrinsic compression 4. pain 5. lump |
|
What are 3 parts of the physical assessment for a pseudoaneurysm?
|
- Palpate pt for lump or bump in groin
- Feel for pulsatility or thrill - Listen for bruit |
|
What is UGCR?
Premedicate w/ ________ for pain Premedicate w/ ___________ in some cases Irrigate groin area w/ 2% _____________ |
- Ultrasound guided compression repair
- Demoral - anti-anxiety drug - lidocaine |
|
UGCR:
1. Visualize the neck while ____________ until flow is ______ in the neck. 2. During ______ evaluate _________ 3. Utilize color to check ____________ 4. Do not compress ______ itself--may force contents into __________ |
1. - compressing
- absent 2. - compression - distal pulses 3. Adequate vein Q 4. - aneurysm - arterial system |
|
What are the 6 pitfalls of UGCR?
1. A very ____________ 2. Procedure may take more than one __________ 3. Very ______ for pt 4. Can tie up ___________ 5. It is not always __________ 6. Difficult on ___________ |
1. long procedure (especially if pt anticoagulated)
2. lab personnel 3. painful 4. lab space 5. successful 6. Large pts |
|
Hematoma is a discrete collection of ____________
May be result of prev ________ procedure Palpable lump- no ___________ No active __________ |
- blood
- catheter - pulsatility - arterial channel |
|
Hematoma duplex eval will show no ___________
May be _____________ formation due to age of thrombus Usually layers of ___________ ________ tx needed for most |
- flow in lumen
- anechoic or echogenic - echogenicity - No |
|
T or F:
The UE venous system is comprised of deep & superficial veins w/the majority of flow returning through the deep system |
FALSE:
UE venous system is comprised of deep & superficial veins w/the majority of flow returning through the SUPERFICIAL system |
|
Most veins in the deep system are accompanied by ___________
Flow return is dependent on ___________ & ___________________ generated ___________ |
artery of same name
- gravity - cardiac output - Pressure gradients |
|
T or F:
Few valves present in communicating veins between deep & superficial systems |
TRUE
|
|
what are the 7 Risk Factors w/UE DVT?
|
1. Central venous catheter
2. Cancer 3. Physical activity (Lack of physical activity) 4. Obesity (associated w/inactivity) 5. Drug abuse (introduces pathogens) 6. Pregnancy 7. IV placement (superficial to deep) |
|
What is another popular name for a central venous catheter?
This catheter is usually in _____________ |
Peripherally Inserted Central Catheter (PICC line)
ax-subcl veins |
|
Chemotherapy can cause DVT because it is _________ on cells and cause them to ____________
|
- Harsh
- become irregular |
|
_____________ pressure should be measured
___________ nutrition is required for pts w/gastrointestinal dysfunction Drug administration of drugs like ____________ |
- central venous
- Parenteral - Antibiotics ??? |
|
What are the 4 most common locations of UE DVT?
Which of the 4 is the most common? |
1. Subclavian vein
2. Internal Jugular vein 3. Axillary 4. Axillary-subclavian (ASVT) **** most common |
|
Vein thrombosis:
_____________ - DVT _________________ Syndrome |
Effort thrombus
Paget Schroetter Syndrome |
|
What is Paget Schroetter syndrome due to?
|
Excessive use of shoulder or arm while in unusual position
Ex: Drywall installer |
|
T or F:
Primary Subclavian-axillary vein thrombosis etiology is the result of multiple etiologic and/or iatrogenic factors |
FALSE:
Primary Subclavian-axillary vein thrombosis has NO DIRECT CAUSE that is obvious on initial evaluation |
|
T or F:
Effort induced ("effort thrombosis") is more common in older males |
FALSE:
Most common victim is YOUNG males * Heavily associated w/occupation |
|
What is the etiology of Secondary subclavian-axillary vein thrombosis?
|
Result of multiple etiologic and/or iatrogenic factors
|
|
Give examples of causes of Secondary subclavian-axillary vein thrombosis
|
- Malignancy
- Heart failure - Infection - Polycythemia - Estrogens - PICC Line, IV line or other catheters |
|
T or F:
Malignancy is the most common cause of Secondary subclavian-axillary vein thrombosis |
FALSE:
PICC line, IV line or catheters are the most common cause |
|
T or F:
In UE DVT there is a gradual onset of swelling in one arm |
FALSE:
ABRUPT onset of swelling in one arm |
|
T or F:
UE DVT occurs more often in females than males |
FALSE:
M > F * 2:1 ratio |
|
T or F:
UE DVT occurs more in the L UE of males than in females |
FALSE:
It does occur more often in males but in the R UE * 3:1 ratio R to L |
|
According to Rutherford, in subc/axill thrombosis the ____________ is involved in most cases
|
Dominant extremity
60-80% |
|
UE DVT clinical features include:
Arm ___________________ _______ or __________ Hx of recent or unusual _____________ Swelling may spread from ____________ Poss tenderness & _____________ |
- heaviness, tingling or ache
- trauma - arm to hand - pain |
|
T or F:
According to Rutherford UE DVT leads to PE most of the time |
FALSE:
Can lead to PE 0-28% of the time |
|
UE DVT dx:
Usually obvious from ____________ Must rule out other causes for such swelling such as ___________ Perform a _____ |
- clinical presentation
- insect bites, allergies, burns - duplex exam |
|
What are the 3 RF's for superficial thrombophlebitis?
Recent ____________ ____________ use _____________ |
- IV (at site where it was placed)
- Drug - Trauma |
|
What 3 veins can superficial thrombophlebitis affect?
Which is the most common? |
1. Cephalic vein **** (most common)
2. Basilic vein 3. Median cubital vein |
|
What are the 5 clinical features of superficial thrombophlebitis?
|
- Swelling
- Tenderness over area - Redness (erythema) - Warm to touch - Palpable bump or lump |
|
A dx of superficial thrombophlebitis is usually obvious from what two things?
|
- Palpation
- Duplex exam |
|
Normal venous flow is _______________
|
- spontaneous
- respiratory phasicity - pulsatility proximally |
|
Abnormal UE venous flow is _____________
|
- absent flow
- continuous flow - diminished flow |
|
T or F:
> Flow w/expiration and < flow w/inspiration |
FALSE:
< Flow w/expiration & > flow w/inspiration |
|
< flow w/expiration = intrathoracic pressure _______
> flow w/inspiration = intrathoracic pressure ______ |
- increases
- dereases |
|
What 3 things are being evaluated for UE duplex evaluation?
|
- Visible thrombus
- Noncompressibility of vessel - Dilation of veins |
|
T or F:
All UE veins should compress under pressure |
FALSE:
All veins EXCEPT subclavian |
|
How do you demonstrate compressibility of the subclavian vein?
|
Sniff test or Doppler
|
|
What is the medical tx for deep vein thrombosis?
What is it followed by? The arm is __________ in forward or extended position supported by _____________ |
- IV Heparin infusion
- Oral Warfarin - elevated - pillow |
|
What are the 3 thrombolysis tx options for deep vein thrombosis?
|
- streptokinase
- urokinase - tPA (tissue plasminogen activator) |
|
T or F:
Superficial thrombophlebitis is always treated |
FALSE:
May do nothing and rescan in 1-2 days |
|
What are the 2 poss tx options for superficial thrombophlebitis
|
- Poss anticoagulation
- Poss anti-inflammatory drug |
|
Thrombectomy's are best performed early and most successful w/ ______________ pts
|
effort thrombosis
|
|
What is a last resort tx for UE DVT?
|
Stents
* Used when other tx fail |
|
Stents must maintain ___________ lumen & are an ______________ procedure
|
- patent
- interventional |
|
What is a popular repair for aneurysms?
|
Endovascular Aneurysm Repair
or Endograft Repair w/Stent-grafts |
|
Indications for placement :
Asymptomatic aneurysms > ____ in diameter All _______________ aneurysms Usually for pts who are at high-risk for ___________ |
- 5 cm
- symptomatic & ruptured - conventional open repair |
|
What is the co-mortality risk if an endograft fails?
|
Will the pt die due to endograft failure and/or the open repair to replace the endograft w/a conventional graft
|
|
T or F:
According to Rutherford the incidence of conversion from endovacular to open operating is rising |
FALSE:
Is FALLING |
|
What pts are defined as high risk?
|
- Pts w/LG threatening aneurysms whose operative risk is excessive
- Risk is in excess of 3-4 times normal on the basis of the heart, lung or liver disease or previous abdominal scarring or infection |
|
The first generation of endografts (__________) employed a tapered ___________ graft w/balloon deployed or __________ stents at each end.
These stents had either hooks of barbs to help prevent ____________ |
- prosthesis
- tubular fabric - self expanding - graft migration |
|
The 2nd generation of endografts was developed in which the fabric is supported throughout by a ___________.
This helps to add __________ and prevent _______ |
continuous metal frame
- column strength - kinking |
|
T or F:
The 2nd generation endografts required hooks or barbs to help prevent graft migration |
FALSE:
This type remains in place w/MINIMAL or NO anchoring devices * 1st generation did require anchoring devices |
|
Most endografts have a ______ (aortic body) w/bifurcated _______ to extend into the CIA
|
- trunk
- legs |
|
Typically the trunk and right iliac leg are ________. Access for this main piece of the endograft is typically inserted thru the ____________. The single piece left Iliac leg is placed by access through the ___________
|
- contiguous
- R CFA - L CFA?? |
|
Because the inside diameter of the delivery system (sheath) is usually __________ the CFA is ___________.
The proximal end is placed _____________ |
- 21 French (7mm or 3/8")
- surgically exposed - infrarenally |
|
Surgeons must consider the distance from the proximal placement to the point where the endograft bifurcates-----why?
|
Because the endograft bifurcation must be proximal to the native aortic bifurcation
|
|
The sheath is withdrawn and the __________ is deployed through the ________ and __________
|
- self expanding endograft
- distal aorta - R CIA |
|
The single piece left iliac leg is placed by access through the ___________
The left iliac leg is inserted slightly (overlapping) into the ___________ of the ____________ |
- L CFA
- left bifurcation branch - main trunk endograft |
|
When the entire endograft is placed satisfactorally under __________ and flow well established, the _______ are closed and the _________ closed
|
- fluoroscopy
- arteriotomies - incision sites |
|
An endoleak is a condition in associated w/endoluminal vascular grafts. Defined by the persistence of blood flow ________ the lumen of the endoluminal graft but _____ an __________ or adjacent ________ being treated by the graft
|
- outside
- within - aneurysm sac - vascular segment |
|
T or F:
A Type I Endoleak is when there is persistent blood flow into the aneurysm sac due to retrograde flow from patent lumbar arteries, IMA or other collateral vessels |
FALSE:
Type I occurs when a persistent channel of blood flow develops due to inadequate or ineffective seal at the graft ends |
|
A type I Endoleak is usually present ________ in the course of tx but may also be encountered ______ when blood erodes thru a _________ around the area of device fixation to the _____________
|
- early
- late - blood clot seal - aortic wall |
|
Type II Endoleak is a ________ of endoleak
It occurs when there is persistent blood flow into the ________ due to retrograde blood flow from patent __________ ______ or other _____________ |
- retrograde
- aneurysm sac - lumbar arteries - IMA - collateral vessels |
|
In systems where there are two or more patent vessels, a situation of ________ and _____ develops creating an _________ flow w/in a channel created w/in the________
|
- inflow
- outflow - active blood - aneurysm sac |
|
Which type of endoleak is related to an inadequate seal or ineffective seal at the graft joint, between segments of overlapping graft segment or rupture of the graft joint
|
Type III endoleak
|
|
A Type III Endoleak may develop early due to __________ or late in the course of the tx when there is __________ of one of the extensions due to __________ or _________
|
- technical problems
-displacement - aneurysm retraction - device breakdown |
|
Type IV Endoleak is related to the __________ and _______ of blood through the ________ of the graft
|
- porosity
- passage - fabric |
|
T or F:
Most grafts used in endovascular devices are preclotted so most of them won't initially leak through |
FALSE:
Most grafts used in endovascular devices are NOT preclotted >>> most fabrics WILL initially leak through |
|
With the development of thinner graft materials what type of endoleak is becoming more common?
|
Type IV
|
|
In a Type V Endoleak:
Aneurysm sac remains _____________ It ____________ But no demonstratable _______ into the _______ can be visualized on current imaging modalities |
- pressurized
- enlarges - flow of blood - sac |
|
T or F:
LE & EU arterial disease are equally as common |
FALSE:
UE not as common as LE |
|
UE arterial disease is _________ life threatening
There are several ___________ or conditions Rarely limb threatening but can have ___________ |
- rarely
- disease processes - gangrene |
|
____________ is the most common arterial occlusive disease
It is often _______ May have _________ syndrome |
- Proximal Subclavian artery
- silent - steal |
|
A subclavian steal could result in __________
Poss reverse flow in ____________ Usually occurs in ______________ |
- cerebral ischemia
- vertebral - older pts |
|
T or F:
R is more common than L |
FALSE:
L more common than R |
|
_________ or more difference in brachial pressure between arms is indicative of ___________
If bilateral may have ______ difference or more Poss ____________ |
30 mmHG
- arterial occlusive disease - 15-20 mmHG - bruits |
|
T or F:
Claudication is common |
FALSE:
Rare due to collateral flow of vertebral |
|
In severe cases a pt may present w/ ___________ ___________ ____________
|
- rest pain
- skin ulcer - gangene |
|
Takayasu's arteritis primarily affects the _______________ which typically results in stenosis or occlusion.
It actually damages the _____________ Disease is more likely in ___________ |
- aorta and its main branches
- intima - women than men |
|
The etiology of Takayus's arteritis is unknown but it is similar to _____________
Which is found in small-medium sized vessels and is more common in ____________ |
- Giant cell arteritis
- elderly pts |
|
Takayasu's can affect ___________ or _____ arteries
Steal is rare because the disease affects _______ of the ___________ |
- subclavian
- axillary - prox and distal segments - subclavian artery |
|
T or F:
Claudication is not possible in Takayasu's disease |
FALSE:
it is possible because the vertebral artery cannot act as collateral |
|
____________ is common in UE
___________ is important to obtain when doing UE exam Why? |
- emboli
- Heart hx - If pt had A-Fib: blood not getting out--creates venous stasis---pt takes blood thinner to prevent clot |
|
T or F:
Clot is usually from heart or a distal aneurysm |
FALSE:
Clot usually from heart or PROXIMAL aneurysm |
|
Clot lodges in ____________
Typically affects smaller vessels _____________ What are 3 pt sx? |
- distal vessels
- usually digits - cold sensitivity, gangrene or purplish digits |
|
What is another name for Buerger's Disease
What happens to the layers of the arterial wall w/this disease? What is the etiology? |
- Thromboangitis obliterans
- All 3 layers of arterial wall are inflammed - Unknown |
|
T or F:
Buerger's disease affects young female smokers most commonly |
FALSE:
young MALE smokers most commonly |
|
Buerger's disease causes occlusion of __________ in the ____________ and ___________
May go undetected until __________ involve forearm arteries |
- small & medium arteries
- hand - digits - lesions |
|
What are the 7 sx a pt w/Buerger's disease may present w/?
1. ___________ in hands/fingers 2. _______________ 3. ___________ changes 4. Skin ___________ 5. ________ pain 6. Intermittent ____________ 7. Fingers ____________ |
1. coldness
2. Paresthesias 3. Skin color (purplish-red) 4. lesions 5. rest 6. claudication 7. cold & damp |
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Thromboangitis obliterans:
May result in ___________ or __________ May lead to ______ of fingers or part of Arterial reconstruction not always poss if ___________ ______ of necrotic tissue may be necessary Cessastion of _____ usually halts progression of the disease |
- digital gangrene or ulceration
- fingers - multiple arteries involved - debridement - smoking |
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UE arterial disease can also be caused by ____________ and _____________
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trauma
occupational problems |
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Trauma Ex:
____ & ____ wounds ___________ mechanisms improperly fitted ____ or ____ in subclavian region _____ forces May have ______ pulses |
- gunshot & knife
- penetrating - shoulder hardness or gear - compression - diminished |
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Occupational problems include:
Excessive force to ___________ _____ induced vasospasm Using hand as a ___________ |
- shoulder or hand
- vibration - hammer |
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Vibration induced vasospasm is known as ______
using tools such as ____________, jackhammers, etc Numbness & _____________ Can progress to ______________ |
- White finger syndrome
- pneumatic drills - tingling - Raynaud's |
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Hypothenar Hammer Syndrome is when a hand is used as hammer and it can lead to ____________
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occlusion of ulnar artery
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Neurologic TOS is nerve compression at the __________ of the ____________
It involves _____________ of hand and fingers |
- lowest trunk
- brachial plexus - Numbness & tingling |
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T or F:
TOS is predominately an arterial issue most of the time |
FALSE:
Neurologic 95% * Venous 1-3% * Artery 1% |
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Vascular TOS is when there is compression of ____________ or _____ at the _________
Typically causes compression of ___________ first |
- subclavian artery or vein
- thoracic outlet - brachial plexus |
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________________ are the most common cause but also common after _____________
Skeletal or soft tissue is affected. Skeletal from ____________. Soft tissue from _______________ |
- Bony abnormalities
- car accidents - cervical, rib or clavicle (costoclavicular) - fibromuscular bands or scalene muscle |
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Compression produces ______________ because its _______
_________ formation over time __________ lesions Artery ____________ _____________ of thrombi |
- subclavian artery stenosis
- at the 1st rib - aneurysm - intimal - thrombosis (usually forms as result of intimal les) - Embolization |
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Why might pts also complain of Raynaud's sxs?
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Bc vasoconstriction restricting blood flow can mimick Raynaud's
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Trauma & thrombosis can occur post ___________
coronary catheter may be done via the _________ |
- catheterization
- brachial artery |
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Poss comps of catheterization can be:
___________ & ___________ Arterial wall _____ which may include an ________ or _______ Arterial ______________ |
- Hematomas & Pseudoaneurysms
- damage - AV fistulae - wall dissection - thrombosis |
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Cath problems pt sx may be:
Pain in _____________ Palpable ___________ _____________ at puncture site _____________ as a result of thromboembolus |
- area of puncture
- lump - pulsatile mass - Digit ischemia |
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Although it is normal for hand/finger blood flow to ______ in response to cold or emotions, __________ of __________arteries resulting in cessation of ____________ is abnormal.
When this occurs the stereotypical sx produced are known as ______________ |
- decrease
- spastic closure - digital - Raynaud's syndrome |
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Raynaud's syndrome can also be described as a condition that exists when sx of _____________ of the fingers or toes occur in response to _________ as well as _______
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- intermittent ischemia
- cold weather - emotional stress |
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_____________ is signs/sxs that occur together and characterize a particular abnormality
Signs/sxs produced by a ___________ abnormality. In Raynauds the _________ or ______________ is the abnormal ______of the digital arteries |
Syndrome
- root - root abnormality or disease - vasospastic closure |
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_____________ is an observable fact or event
The same ________ & __________ produced by a fact or event other than the _________________ If recognized however, the other fact or event can be recognized as the root abnormality and can become a __________ in itself |
- Phenomenon
-signs & sxs - root abnormality - syndrome |
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Vasconstrictive + Atherosclerotic _____________
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induced ischemia
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What are the two other names for Raynaud's Syndrome?
What is the other name for Raynaud's Phenomenon? |
- Raynaud's disease
- Vasospastic Raynaud's Syndrome - Obstructive Raynaud's Syndrome |
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T or F:
In vasospastic Raynaud's syndrome the color change observed is red to white to blue |
FALSE:
White to blue to red |
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Raynaud's is abnormal __________ of digital arterial flow that presents w/ stereotypical sxs
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spastic closure
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T or F:
Vasospasm completely restricts arterial flow near the digits producing cyanosis |
FALSE:
Vasospasm completely restricts arterial flow near the digits causing a WHITE, waxy pallor of one or more fingers/toes |
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What produces cyanosis w/Raynauds?
The first returning arterial blood is rapidly ___________ |
The relaxation of the vasospasm
- desaturated of oxygen>>>produces cyanosis/blueness |
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T or F:
As blood flow decreases the hyperemic condition replaces cyanosis w/rubor (redness) |
FALSE:
As blood flow INCREASES the hyperemic condition replaces cyanosis w/rubor (redness) |
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A subcategory of Raynaud's syndrome is called ____________
Arteries close due to abnormal __________ Regarded as a ___________ |
Primary raynaud's disease
(also described as Vasospastic Raynaud's Syndrome & True Raynaud's syndrome) - vasospasm - disease |
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The digital arteries of normal individuals is relativlely ___________ to cold, those of pts w/primary Raynaud's disease display an ability to constrict w/complete closure occurring when the _______________
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- unresponsive
- skin temperature falls below a threshold level |
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What is the subcategory of Raynaud's Phenomenon
Arteries are occluded or nearly occluded due to a ____________, thrombus, atherosclerosis or ____________ |
Secondary Raynaud's Phenomenon (Also Obstructive Raynaud's Syndrome)
- fixed vasculitis - extrinsic compression from vasoconstriction |
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When this fixed flow restricting lesion is combined w/ the normal vasoconstriction near the digits flow to the digits ____________
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ceases or nearly ceases
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Arteriolar constriction is usually well tolerated but when it is superimposed on a substrate of ___________, prev adequately perfused fingers may become _______. This is the mechanism responsible for the appearance of _______________
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- fixed arterial obstruction
- ischemic - Raynaud's Phenomenon |
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Primary Raynaud's Disease:
Etiology is ______________ ___________ only (not from secondary causes) No _________________ disease Arteries ___________ or spasm causing complete _______ during the spasm Women ________ than Men common among _____ who have occupations involving use of _____________ Age 11- __________ Initiated by _______ to cold exposure or increase in __________ |
- Idiopathic
- vasospasm - occlusive (atherosclerosis or arteritis) - constrict - closure - more (4:1) - men - jackhammers/or other vibratory equipment - 45 - hypersensitivity - sympathetic nerve stimulation (emotional disress) |
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Secondary Raynaud's Phenomenon:
Digital or ______ arteries are nearly occluded/occluded Raynaud's sxs ___________ to other medical conditions such as ____________ disorders, hematologic ______, drugs, ___________ & __________, traumatic _______, and __________ disease |
- Palmar
- secondary - connective tissue - disorders - neoplasms & toxins - arteritis - Buerger's |
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For dx of Raynaud's syndrome what is obtained?
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- Segmental pressures
- Finger pressures - PVR or PPG readings |
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PPG readings on a normal digit will demonstrate _____
PPG readings on a Primary RS pt will demonstrate ___ PPG readings on a Secondary RS pt will demo _______ |
- normal waveform contour
- a peaked waveform contour - a flattened, slow to rise waveform |
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On which PPG reading would one expect to see a "tardus-parvus" waveform?
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PPG readings on a Secondary RS pt
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____________ test is done for RS
Pt warmed in lab for several minutes, baseline studies performed w/ |
cold tolerance
PVR, PPG, or pressure measurement of digits |
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T or F
cold tolerance test is very useful when a patient has secondary RS. |
False, very little value
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