Risk factors, clinical manifestations, and management of thoracic and abdominal aneurysms, venous insufficiency, venous stasis ulcers, PAD, acute arterial ischemia. (be sure to know the difference in venous and arterial disease!)
PAD (thickening of the artery walls, which results in the progressive narrowing of the arteries of the upper and lower extremities)
-risk factors: tobacco use (most important), hyperlipidemia, elevated high sensitivity C-reactive protein, diabetes (occurs much earlier), uncontrolled hypertension, increases with age, African Americans, 2 times higher in Mexican/Hispanic American women then white women
-PAD is a marker for advanced systemic artherosclerosis**
-atherosclerosis is the leading cause**
-these patients are more likely to suffer from CAD and cerebral artery disease
-artherosclerosis= migration and replication of smooth muscle cell, deposition of connective tissue, lymphocyte and macrophage infiltration, and accumulation of lipids
-clinical symptoms occur when the vessel is 60 to 70 percent occluded
Thoracic and Abdominal aortic aneurysms
-aneuryisms happen more in men than women, increases with age
- most occur as abdominal aortic aneurisms
-thoracic= often asymptomatic, chest pain extending into interscapular area (most common symptom), hoarseness, dysphagia
-abdominal= often asymptomatic, abdominal pain, back pain, pulsatile mass pre-umbilical and slightly to the left
-abdominals a. are caused by artherosclerosis (male gender, over 65, high blood pressure, high cholesterol, and tobacco use are the risk factors)
- growth rates of aneurysms are lowered by using statins and antibiotics
- occasionally aneurysms spontaneously embolize plaque , causing “blue toe syndrome”
- if rupture in the thoracic and abdominal area then the patient will most likely die due to hemorrhage
-signs of rupture- diaphoresis, pallor,