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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?

Who performs these?

- 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. Hx & PA ______

2. Results of ____ and _____ exams

3. Consideration of pt's existing ______ or ______ for the ____________

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. Initial & long term _________
2. _________ - morbidity & mortality
3. __________ effectiveness
4. Consequences ____________

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 ____________.

Careful consideration must be given to _________

- 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:

A balloon is more expensive than a stent

FALSE:

Balloon is CHEAPER than a stent

Balloon dilation:

1. The technique is actually ___________. Plaque is _____, ____ & ___________

2. Non diseased area of the artery, the ______ is ______

3. The plaque is partially sheared from its _______ and pushed into the _______________

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

There can be a _________ in the vessel at the puncture site

There can alsobe the formation of a ____________ or __________

- 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


What is a negative of this type of stent?

self expanding stent

- spring action

- It is difficult to length match w/the lesion

Nitonol stents are ________ while cool

they expand to _______________ when ___________ to ____________

- 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:

Profundaplasty may prevent BK amp

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:
- Longitudinal _______________
- __________ removed
- Common for _______ endarterectomy

- arteriotomy

- lesion

- carotid
*especially if plaque is hard

For a semi-closed endarterectomy:

Transverse or longitudinal ____________ at _____ and ____ extent of lesion. (Advantage of seeing the _______ of the _____________)

- 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:

Only one arteriotomy--but the distal end of the atheroma is __________

Performed by use of long-jawed clamps and or a ________

Often times the clamp jaws serve as the ________ which helps remove the ____________ from the ___________

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)

- Intraoperative Duplex

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 ________________

It is completely separate from the artery except for the _____________ thru which blood travels to reach it.

- 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 ____________

_________ is the classic sign seen w/pseudos

- 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
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
UE arterial disease can also be caused by ____________ and _____________
trauma
occupational problems
Trauma Ex:

____ & ____ wounds
___________ mechanisms

improperly fitted ____ or ____ in subclavian region
_____ forces

May have ______ pulses
- gunshot & knife
- penetrating

- shoulder hardness or gear
- compression

- diminished
Occupational problems include:

Excessive force to ___________
_____ induced vasospasm
Using hand as a ___________
- shoulder or hand
- vibration

- hammer
Vibration induced vasospasm is known as ______

using tools such as ____________, jackhammers, etc

Numbness & _____________

Can progress to ______________
- White finger syndrome

- pneumatic drills

- tingling

- Raynaud's
Hypothenar Hammer Syndrome is when a hand is used as hammer and it can lead to ____________
occlusion of ulnar artery
Neurologic TOS is nerve compression at the __________ of the ____________

It involves _____________ of hand and fingers
- lowest trunk
- brachial plexus

- Numbness & tingling
T or F:

TOS is predominately an arterial issue most of the time
FALSE:

Neurologic 95%

* Venous 1-3%
* Artery 1%
Vascular TOS is when there is compression of ____________ or _____ at the _________

Typically causes compression of ___________ first
- subclavian artery or vein
- thoracic outlet

- brachial plexus
________________ 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
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
Why might pts also complain of Raynaud's sxs?
Bc vasoconstriction restricting blood flow can mimick Raynaud's
Trauma & thrombosis can occur post ___________

coronary catheter may be done via the _________
- catheterization

- brachial artery
Poss comps of catheterization can be:
___________ & ___________

Arterial wall _____ which may include an ________ or _______

Arterial ______________
- Hematomas & Pseudoaneurysms

- damage
- AV fistulae
- wall dissection

- thrombosis
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
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
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 _______
- intermittent ischemia

- cold weather

- emotional stress
_____________ 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
_____________ 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
Vasconstrictive + Atherosclerotic _____________
induced ischemia
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
T or F:

In vasospastic Raynaud's syndrome the color change observed is red to white to blue
FALSE:

White to blue to red
Raynaud's is abnormal __________ of digital arterial flow that presents w/ stereotypical sxs
spastic closure
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
What produces cyanosis w/Raynauds?

The first returning arterial blood is rapidly ___________
The relaxation of the vasospasm

- desaturated of oxygen>>>produces cyanosis/blueness
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)
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
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 _______________
- unresponsive

- skin temperature falls below a threshold level
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
When this fixed flow restricting lesion is combined w/ the normal vasoconstriction near the digits flow to the digits ____________
ceases or nearly ceases
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 _______________
- fixed arterial obstruction
- ischemic

- Raynaud's Phenomenon
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)
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
For dx of Raynaud's syndrome what is obtained?
- Segmental pressures
- Finger pressures
- PVR or PPG readings
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
On which PPG reading would one expect to see a "tardus-parvus" waveform?
PPG readings on a Secondary RS pt
____________ 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
T or F
cold tolerance test is very useful when a patient has secondary RS.
False, very little value