peripheral vascular diseases

peripheral vascular diseases

1. Vasculitis

   • Inflammation of the blood vessel wall
     • Nonspecific symptoms of inflammation (e.g., fever, fatigue, weight loss, and myalgias)
       • Symptoms of organ ischemia—due to luminal narrowing or thrombosis of the inflamed vessels

2. HTN

   • PRIMARY HTN
     • . HTN of unknown etiology (95% of cases)
       • Risk factors include age, race (increased risk in African Americans, decreased risk in Asians), obesity, stress, lack of physical activity, and high-salt diet.
   • SECONDARY HTN
     • HTN due to an identifiable etiology (5% of cases)
       • Renal artery stenosis is a common cause (renovascular hypertension)

3. ATHEROSCLEROSIS

   • Risk factors :
     • Arterial HT... Tobacco smoke... Hereditary... Endocrine.. Reduced physical activity... Obesity... Male gender... Age ...stress
   • Causes of intermittent claudication
     • Most commonly, intermittent (or vascular or arterial) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockages resulting in arterial insufficiency.
   • Complications :
     • aneurysmal dilatation and thrombo –embolism.
     • Ischemic Heart Disease & Myocardial Infarction
     • chronic ischemia, infarction.
     • ischemic bowel disease, infarction.
     • intermittent claudication
   • Diagnosis
     • Magnetic resonance angiography... Duplex ultrasonography

4. arterioloscelrosis

   • A. Narrowing of small arterioles; divided into hyaline and hyperplastic types
   • Hyaline arteriolosclerosis is caused by proteins leaking into the vessel wall, producing vascular thickening; proteins are seen as pink hyaline on microscopy.
   • Hyperplastic arteriolosclerosis
     • involves thickening of vessel wall by hyperplasia of smooth muscle ('onion-skin appearance).
     • 1. Consequence of malignant hypertension
     • 2. Results in reduced vessel caliber with end-organ ischemia
   • MONCKEBERG MEDIAL CALCIFIC SCLEROSIS
     • A. Calcification of the media of muscular (medium-sized) arteries; nonobstructive
     • B. Not clinically significant; seen as an incidental finding on x-ray or mammography

5. Aortic dissection

   • A. Intimal tear with dissection of blood through media of the aortic wail
     • B. Occurs in the proximal 10 cm of the aorta (high stress region) with preexisting weakness of the media
       • Most common cause is hypertension (older adults); also associated with inherited defects of connective tissue (younger individuals)
         • D. Presents as sharp, tearing chest pain that radiates to the back

6. Aneurysm

   • THORACIC ANEURYSM
     • 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
       • C. Major complication is dilation of the aortic valve root, resulting in aortic valve insufficiency
   • ABDOMINAL AORTIC ANEURYSM
     • Balloon-like dilation of the abdominal aorta; usually arises below the renal arteries, but above the aortic bifurcation
       • D. Major complication is rupture, especially when > 5 cm in diameter; presents with triad of hypotension, pulsatile abdominal mass, and flank pain

7. Bruits

   • Carotid bruits
     • Carotid stenosis

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