peripheral vascular diseases

Vasculitis
1. Inflammation of the blood vessel wall
  1. Nonspecific symptoms of inflammation (e.g., fever, fatigue, weight loss, and myalgias)
    1. Symptoms of organ ischemia—due to luminal narrowing or thrombosis of the inflamed vessels
HTN
1. PRIMARY HTN
  1. . HTN of unknown etiology (95% of cases)
    1. Risk factors include age, race (increased risk in African Americans, decreased risk in Asians), obesity, stress, lack of physical activity, and high-salt diet.
2. SECONDARY HTN
  1. HTN due to an identifiable etiology (5% of cases)
    1. Renal artery stenosis is a common cause (renovascular hypertension)
ATHEROSCLEROSIS
1. Risk factors :
  1. Arterial HT... Tobacco smoke... Hereditary... Endocrine.. Reduced physical activity... Obesity... Male gender... Age ...stress
2. Causes of intermittent claudication
  1. Most commonly, intermittent (or vascular or arterial) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockages resulting in arterial insufficiency.
3. Complications :
  1. aneurysmal dilatation and thrombo –embolism.
  2. Ischemic Heart Disease & Myocardial Infarction
  3. chronic ischemia, infarction.
  4. ischemic bowel disease, infarction.
  5. intermittent claudication
4. Diagnosis
  1. Magnetic resonance angiography... Duplex ultrasonography
arterioloscelrosis
1. A. Narrowing of small arterioles; divided into hyaline and hyperplastic types
2. Hyaline arteriolosclerosis is caused by proteins leaking into the vessel wall, producing vascular thickening; proteins are seen as pink hyaline on microscopy.
3. Hyperplastic arteriolosclerosis
  1. involves thickening of vessel wall by hyperplasia of smooth muscle ('onion-skin appearance).
  2. 1. Consequence of malignant hypertension
  3. 2. Results in reduced vessel caliber with end-organ ischemia
4. MONCKEBERG MEDIAL CALCIFIC SCLEROSIS
  1. A. Calcification of the media of muscular (medium-sized) arteries; nonobstructive
  2. B. Not clinically significant; seen as an incidental finding on x-ray or mammography
Aortic dissection
1. A. Intimal tear with dissection of blood through media of the aortic wail
  1. B. Occurs in the proximal 10 cm of the aorta (high stress region) with preexisting weakness of the media
    1. Most common cause is hypertension (older adults); also associated with inherited defects of connective tissue (younger individuals)
      1. D. Presents as sharp, tearing chest pain that radiates to the back
Aneurysm
1. THORACIC ANEURYSM
  1. Due to weakness in the aortic wall. Classically seen in tertiary syphilis; endarteritis of the vasa vasorum results in luminal narrowing, decreased flow, and atrophy of the vessel wall. Results in a 'tree-bark' appearance of the aorta
    1. C. Major complication is dilation of the aortic valve root, resulting in aortic valve insufficiency
2. ABDOMINAL AORTIC ANEURYSM
  1. Balloon-like dilation of the abdominal aorta; usually arises below the renal arteries, but above the aortic bifurcation
    1. D. Major complication is rupture, especially when > 5 cm in diameter; presents with triad of hypotension, pulsatile abdominal mass, and flank pain
Bruits
1. Carotid bruits
  1. Carotid stenosis

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peripheral vascular diseases

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