LE Peripheral Arterial (A&P & Fluid Dynamics)

CVT Vascular 1

What are inflow vessels?

the more proximal (aorta-iliac) in the body

Which anatomical location is used to differentiate location of inflow & outflow?

inguinal ligament

What are outflow vessels?

vessels at the inguinal crease & below

Which vessels are considered inflow vessels?

abdominal / distal aorta

common iliac arteries

external iliac arteries

What does the abdominal aorta bifurcate into & where at?

right & left common iliac arteries

level of the umbilicus (belly button)

What does the common iliac arteries bifurcate into & where at?

internal & external iliac artery

lumbosacral junction

Which vessel descends into the pelvis & provides arterial flow to the pelvic wall, gluteal muscle, pelvic viscera, thigh & perineum?

internal iliac arteries (hypogastric)

Which vessel is a continuation of the common iliac artery that then continues to the inguinal ligament in the groin?

external iliac arteries

What branches arise off the external iliac artery?

inferior epigastric artery

deep circumflex artery

What does the inferior epigastric artery supply blood to?

abdominal muscle & skin

What does the deep circumflex artery supply blood flow to?

abdominal muscles

Which inflow vessels can anastomose (connect) to other branches as collaterals?

internal iliac arteries (hypogastric)

deep circumflex artery

Which vessels are considered outflow vessels?

common femoral artery

deep femoral (profunda femoris) artery

superficial femoral artery

popliteal artery

tibioperoneal trunk

When does the distal external iliac become the common femoral?

as it passes underneath the inguinal ligament in the groin

What does the common femoral artery bifurcate into?

superficial femoral artery & deep femoral artery

Which outflow vessel tends to develop into a collateral pathway for the lower extremity in situations of significant stenosis or occlusion?

deep femoral / profunda femoris

What is the hunters / adductors canal?

the location for where the SFA transitions into the popliteal in the distal thigh

also a common area for stenosis

Which branches supply flow to the muscles, knee joint & skin?

genicular (knee area) branches off the popliteal artery

Which vessels are considered runoff vessels?

anterior tibial artery

dorsalis pedis artery

posterior tibial artery

peroneal artery

What is the first branch off the distal popliteal artery?

anterior tibial artery

When does the anterior tibial turn into the dorsalis pedis?

in the distal segment at the level of the ankle

What branches off the dorsalis pedis artery?

first dorsal metatarsal

deep plantar artery

What vessel does the deep plantar artery connect to to complete the plantar arch of the foot?

lateral plantar artery

What does the posterior tibial artery supply?

sole of the foot

What does the peroneal artery supply?

structures in the lateral aspect of the leg

Which vessel extends down the medial side of the fibula bone?

peroneal artery

What is the most significant factor in peripheral resistance?

vessel diameter

What is the primary site peripheral resistance occurs at?

the arterioles

What is hydrostatic pressure?

force of gravity on a column of fluid

What is the atmospheric pressure considered to be at in the right atrium?

zero

When standing, where is pressure the highest?

in the lower portion of the body (ankle)

What does the peripheral arterial system use to categorize blood flow?

the phasicity of the waveform

What type of waveform is seen when a normal to mild disease is present?

multiphasic

What type of waveform is seen when a significant disease is present?

monophasic

In a normal state, what resistance type should all the arteries in the peripherals be?

high resistance

What type of doppler is used for physiologic testing?

CW doppler

What type of doppler is used for duplex images?

PW doppler

How does the evolution of PAD present in the lower extremities?

claudication

ischemic rest pain

tissue loss

What are some risk factors of peripheral arterial disease (PAD)?

diabetes

hypertension

hyperlipidemia

smoking

family history

age

male gender

Which vessels are more likely to have an occlusive disease for a diabetic patient?

distal popliteal artery & tibial vessels

this is due to medial wall calcification developing in the arterial wall

Why are ulcerations, gangrenous tissue & amputations more prevalent in the diabetic population?

due to neuropathy that causes poor sensation leading to unknowing trauma of lower leg & foot

Why can hypertension be a risk factor for PAD?

exacerbates the formation of atherosclerotic plaque due to increased force of the shearing of blood at points of bifurcations

Why can hyperlipidemia be a risk factor for PAD?

elevated plasma lipids that are insoluble in water accumulate & contribute to the formation of plaque

What is claudication?

pain that occurs in the muscle while walking / exercising that subsides with rest due to inadequate blood supply to the exercising muscle

Which vessels would be suspected to be involved with buttock disease?

aorta-iliac

Which vessels would be suspected to be involved with thigh claudication?

distal external iliac

common femoral

Which vessels would be suspected to be involved with calf claudication?

femoral-popliteal

Where do symptoms typically occur with ischemic rest pain?

forefoot

heal

toes

NOT calf region

What are the acute arterial signs & symptoms?

pain (severe)

pallor (pale)

pulselessness

paresthesia

paralysis

poikilothermia (coolness)

What are some manifestations of disease?

atherosclerosis (embolism)

aneurysm

dissection (dissecting aneurysm)

pseudoaneurysm

arteritis (buerger’s)

coarctation of aorta

vasospastic disorder

entrapment

Where are aneurysms most likely in the lower extremities?

common femoral & popliteal (on slide 19)

infrarenal (below kidneys) abdominal aorta (on slide 20)

(im not sure which is the more correct one)

What is an aneurysm?

weakening of the arterial walls causing bulging or dilation

What is the difference between a true & false aneurysm?

true involves all 3 walls

false doesn’t

What is a fusiform aneurysm?

circumferential dilation of the arterial wall

What is a saccular aneurysm?

localized out-patching of the arterial wall

What is a dissecting aneurysm?

a tear in the intimal wall along with weakening of the arterial wall causing an aneurysmal dilation

Where does a dissecting aneurysm commonly occur in?

thoracic aorta

What is a pseudoaneurysm?

focal “pouch or sac” outside of the artery with high pressure blood flow due to a hole in the arterial wall

What is a pseudoaneurysm fed by?

a tract coursing directly from the main artery

What are pseudoaneurysms typically caused by?

an iatrogenic (by medical treatment) injury while trying to gain arterial access

What is a hematoma?

blood leaking into the surrounding tissue, doesn’t have a tract due to inactive flow

What is an arterial-venous connection?

abnormal connection between the vein & artery due to injury (likely from attempted access with a needle)

What is buerger’s disease also known as?

thrombongiitis obliterans

What is buerger’s disease?

a form of arteritis where the patient presents with occlusion of the distal arteries

often in males & heavy smokers

What is coarctation of the aorta?

a congenital anomaly where there is narrowing of the thoracic aorta, can result in hypertension, lower extremity ischemia, decreased pulses & pressures

What are vasospastic disorders?

occurs when the vessels in the hands & feet vasoconstrict reducing the blood flow in the giner & toes

What are some symptoms of vasospastic disorders?

skin color changes (pallor, cyanosis, & rubor)

paresthesia

What is raynaud’s phenomenon?

intermittent ischemia of the fingers & toes due to cold exposure or stress

What is the difference between primary (idiopathic) & secondary raynaud’s?

primary : ischemia due to arterial spasm in digits, may be hereditary

secondary : vasoconstriction of arterioles superimposed on fixed arterial obstruction

Which entrapment syndrome is most common?

popliteal entrapment

Why does popliteal entrapment occur?

there is compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands

Why might someone’s skin turn pallor?

lack of blood supply

Why might someone’s skin turn rubor?

infection or hyperemia causing vessels to dilate or be damaged

Why might someone’s skin turn cyanotic?

concertation of deoxygenated hemoglobin

What is livedo reticularis?

purple patches (like bruises) at dorsum of foot due to dilated capillary & venule filling

How do arterial ulcers tend to present?

deep with regular borders & often located over the tibial (shin) area (bony areas)

What are trophic changes?

loss of hair, shiny skin, or a scaly appearance due to lack of blood flow

How can you use capillary filling to detect decreased arterial perfusion?

apply manual pressure to skin, upon release the skin should quickly turn from white to its original color — if the refill time is delayed it suggests an abnormality

What is dependent rubor?

blood only seems to flow to the lower extremities when lowered appearing red, instead of white when raised & lacking blood flow

What does each number on the palpation scale represent?

0 = no pulse

1+ = weak pulse

2+ = good pulse

3+ = strong pulse

4= + bounding pulse

What kind of pulse can aneurysms present with?

bounding

What are bruits?

abnormal sounds heard on auscultation

What does each number on the bruit scale represent?

1+ = mild

2+ = moderate

3+ = severe

What are bruits graded off of?

their strength & duration