Diseases of aorta, peripheral arterial diseases

PAD usually affects which arteries

aorto-iliac or infra-inguinal

chronic lower limb ischemia - risk factors

smoking, dm, hypercholesterolemia, htn

premature atherosclerosis in >45yo may be associated w/

thrombophilia, hyperhomocysteinemia

Fontaine classification PAD

1. asymptomatic

2. intermittent claudication

3. rest/nocturnal pain

4. necrosis/gangrene

symptoms chronic lower limb ischemia

intermittent claudication in calf, relieved by rest

patients w/ aorto-iliac disease may experience what symptoms

pain in butt, hip, thigh, ED

signs chronic lower limb ischemia

cold, dry skin, lack hair, pulses absent, ulcer, dark toes/gangrene

investigations chronic lower limb ischemia

abpi - <0.9, duplex + doppler, imaging

medical management chronic lower limb ischemia

naftidrofuryl oxalate (vasodilator)

when is percutaneous transluminal angioplasty or bypass indicated in chronic lower limb ischemia

severe/disabling symptoms

when is amputation necessary in chronic lower limb ischemia

severe ischemia with unreconstructable arterial disease

symptoms acute lower limb ischemia

pain, pallor, paresthesia, paralysis, perishingly cold

signs acute lower limb ischemia

cold limb, marbling skin, pulses absent, less sensation if severe ischemia

etiology acute lower limb ischemia

embolic (thrombus or afib) or thrombotic

medical management acute lower limb ischemia

heparin, if mi or afib → warfarin

surgical treatment acute lower limb ischemia

graft thrombolysis if occluded graft, angioplasty if stenosis, embolectomy, bypass graft, fasciotomy if compartment syndrome

abdominal aortic aneurysms

in renal a, can be secondary to atherosclerosis, infection, traumatic, genetic

symptoms abdominal aortic aneurysms

asymptomatic unless rupture causes severe pain, hypotension, tachycardia, anemia and death

signs abdominal aortic aneurysms

pulsatile expansile abd mall felt, ‘trash feet’, discolored digits

medical treatment abdominal aortic aneurysms

control htn, lipid lowering meds

surgical treatment abdominal aortic aneurysms

open aneurysm repair, endovasc stent

thoraco-abd aneurysms are associated w/

asc - marfan, htn

desc - atherosclerosis

clinical features thoraco-abd aneurysm

asymptomatic, rupture → shock

chest symptoms from expansion

management thoraco-abd aneurysm

>6cm → OP or stent

acute aortic syndromes

aortic dissection, intramural hematoma, penetrating aortic ulcers

type A vs B aortic dissection

A - arch + valve prox to l subclavian a

B - desc aorta distal to l subclavian a

symptoms acute aortic syndromes

sudden onset severe and central chest pain

signs acute aortic syndrome

shocked, neuro symptoms

investigations acute aortic syndromes result

widened mediastinum

management acute aortic syndromes

antihtn, b blockers + vasodilators

stents, surgery if dissection

raynauds

bilateral spasm digital arteries precipitated by cold

clinical features raynauds

skin pallor then cyanosis then redness secondary to hyperemia

chronic + severe = infarction and digital loss

management raynauds

sympathectomy or prostacyclin infusion

takayusu disease

females, vasulitis aortic arch, pain and tender, absent peripheral pulses, htn

thromboangiitis obliterans (buergers)

young men who smoke, inflammatoion vessels, claudication and rest pain → gangrene

cardiovasc syphilis

uncomplicated aortitis, aortic aneurysms, aortic valvulitis + regurg, stenosis coronary