Flank pain, hypotension, *pulsatile abdominal mass* Aortic Aneurysm
Sudden onset *tearing chest pain, between scapulae*. Diminished pulses. Chest radiograph
Aortic Dissection
shows widened mediastinum
The 6 P's: *Pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia* Arterial embolism/thrombosis
*Jaw claudication and headache*, scalp pain elicited by touching the scalp or combing the
Giant cell arteritis
hair, *ESR > 100*, diagnosed with Temporal artery biopsy, treat with high dose prednisone
*Intermittent claudication*, Ankle-brachial-index< 0.9, Arteriography is gold standard for
Peripheral artery disease
diagnosis
Dull pain, erythema, induration of vein, *palpable cord*. Venous duplex ultrasound Gold
Phlebitis/thrombophlebitis
Standard for diagnosis
Dilated tortuous superficial veins, *lower extremity pain after sitting/standing*, venous stasis
Varicose veins
ulcers, ankle edema, treat with leg elevation and compression stockings
Edema, atrophic shiny skin, brawny induration, *stasis dermatitis, brown hyperpigmentation*,
varicosities, ulcers above medial malleolus. Diagnose with ABI, *Trendelenburg tests* and Venous insuflciency
ultrasound
*Unilateral swelling of lower extremity*, D-dimer, venous duplex ultrasound first line imaging,
Venography gold standard, *Virchow's triad*: stasis, vascular injury, hypercoagulable state Venous thrombosis
(OCP, cancer, surgery, factor V Leiden), Homan sign
What is an aortic aneurysm? Abnormal dilation of the aorta caused by weakening of the arterial wall
Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or
What are the causes of an aortic aneurysm?
acquired connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome).
Men (10:1 male-to-female ratio). Other risk factors include hypertension, atherosclerosis,
Are aortic aneurysms more common in men or women?
diabetes, hyperlipidemia, smoking, syphilis, Marfan disease, and Ehlers-Danlos disease.
Aortic aneurysms are usually asymptomatic but can cause pain and lead to ischemia, throm-
What are the symptoms of an aortic aneurysm?
boembolism, spontaneous dissection, and rupture, which may be fatal.
Diagnosis is by imaging tests (eg, ultrasonography, CT angiography, magnetic resonance
Diagnosis of an aortic aneurysm?
angiography, aortography).
What is the gold standard diagnostic modality of a AAA? Angiography is GOLD STANDARD for evaluation of AAA
MC location of AAA? Infrarenal aorta
What size should you refer AAA to vascular surgeon? > 4.5 cm
No further testing if aorta < 3.0 cm diameter
ÏRepeat US yearly if aorta 3.0 - 4.4 cm
How do you follow an AAA? ÏRepeat US every 6 months if aorta 4.5 - 5.0 cm (Referral to vascular surgery at this stage)
ÏRepeat US every 3 months if aorta 5-5.4 com
Ï> 5.5 or > 0.5 cm expansion in 6 months - Immediate surgical repair (even if asymptomatic)
What is the screening recommendation for AAA? Ultrasound, if male >65 and ever a smoker
Tx of ruptured AAA? Emergent surgery
A patient presents with sudden-onset chest and back pain. Further work-up reveals an Suspect an acute aortic dissection when chest or back pain is associated with ischemic and/or
ischemic right leg. What is your diagnosis? neurologic deficits
1/9
, An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's
What is an aortic dissection?
main artery (aorta)
Interscapular back pain. Many patients will complain of a "ripping" sensation in their back as
What is the most common symptom of aortic dissection?
the dissection is taking place.
Blood pressure and pulse ditterences between arms and/or legs, cardiac tamponade, and
What physical findings suggest an acute aortic dissection?
aortic insuflciency murmur
Proximal ascending aorta (60%)
ÏTwenty percent of aortic dissections are found between the origin of the left subclavian and
Where do aortic dissections most often occur?
the ligamentum arteriosum in the descending aorta
Ï10% are found in the aortic arch or the abdominal aorta
Uncontrolled hypertension is the most important risk factor. Additional risk factors include
Risk factors for aortic dissection?
trauma, cocaine, Marfans, Turners
Widening of the superior mediastinum, a hazy or enlarged aortic knob, an irregular aortic
What may an x-ray of a patient with an aortic dissection reveal? contour, separation of the intimal calcification from the outer aortic contour that is greater
than 5 mm, a displaced trachea to the right, and cardiomegaly.
What is the gold standard for evaluation of aortic dissection? MRI Angiography is the gold standard for evaluation
ÏStanford type A: Always involves the ascending aorta but could include the descending aorta
Describe the Stanford classification of aortic dissections
ÏStanford type B: Involves the descending aorta only
Use the mnemonic "bad"
Type I: both aorta
Debakey classification of thoracic aortic dissection?
Type II: ascending aorta
Type III: descending
Patients with Stanford type B and (type III) are eligible for medical, rather than, surgical
What dissections can be treated medically? treatment. Surgical treatment may be required for those with uncontrollable pain, aortic
bleeding, hemodynamic instability, increasing hematoma size, or an impending rupture.
ÏLower Blood pressure
Management of aortic dissections based on Stanford classification? ÏType A (proximal aortic dissection) requires surgical management
ÏType B (distal aortic dissection) - medical management initially, surgery only if needed
Which drugs should be administered to lower the BP in a patient with thoracic aortic Sodium nitroprusside. A beta-blocker should also be used to reduce the dp/dt (propagation
dissection? speed)
Injury to the tunica intima (innermost layer of the aorta) allows blood to flow between the
Why does an aortic dissection lead to profound shock? layers of the aortic wall, forcing the layers apart. Blood flows into a false lumen and not
systemic circulation.
20% of afflicted individuals die within 24 hours, 60% within 2 weeks, and 90% within 3 months.
What is the prognosis of an untreated aortic dissection? With surgical treatment, the 10-year survival rate is 40%. Redissection occurs in 25% of these
patients within 10 years of the original episode
Acute occlusion of an artery, usually by embolization; other causes include acute thrombosis
What is acute arterial occlusion?
of an atheromatous lesion, vascular trauma
The "six P's": Pain, Paralysis Pallor, Paresthesia, Polar (some say Poikilothermia—you pick),
What are the classic signs/ symptoms of acute arterial occlusion?
and Pulselessness (You must know these!)
2/9
Sudden onset *tearing chest pain, between scapulae*. Diminished pulses. Chest radiograph
Aortic Dissection
shows widened mediastinum
The 6 P's: *Pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia* Arterial embolism/thrombosis
*Jaw claudication and headache*, scalp pain elicited by touching the scalp or combing the
Giant cell arteritis
hair, *ESR > 100*, diagnosed with Temporal artery biopsy, treat with high dose prednisone
*Intermittent claudication*, Ankle-brachial-index< 0.9, Arteriography is gold standard for
Peripheral artery disease
diagnosis
Dull pain, erythema, induration of vein, *palpable cord*. Venous duplex ultrasound Gold
Phlebitis/thrombophlebitis
Standard for diagnosis
Dilated tortuous superficial veins, *lower extremity pain after sitting/standing*, venous stasis
Varicose veins
ulcers, ankle edema, treat with leg elevation and compression stockings
Edema, atrophic shiny skin, brawny induration, *stasis dermatitis, brown hyperpigmentation*,
varicosities, ulcers above medial malleolus. Diagnose with ABI, *Trendelenburg tests* and Venous insuflciency
ultrasound
*Unilateral swelling of lower extremity*, D-dimer, venous duplex ultrasound first line imaging,
Venography gold standard, *Virchow's triad*: stasis, vascular injury, hypercoagulable state Venous thrombosis
(OCP, cancer, surgery, factor V Leiden), Homan sign
What is an aortic aneurysm? Abnormal dilation of the aorta caused by weakening of the arterial wall
Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or
What are the causes of an aortic aneurysm?
acquired connective tissue disorders (eg, Marfan syndrome, Ehlers-Danlos syndrome).
Men (10:1 male-to-female ratio). Other risk factors include hypertension, atherosclerosis,
Are aortic aneurysms more common in men or women?
diabetes, hyperlipidemia, smoking, syphilis, Marfan disease, and Ehlers-Danlos disease.
Aortic aneurysms are usually asymptomatic but can cause pain and lead to ischemia, throm-
What are the symptoms of an aortic aneurysm?
boembolism, spontaneous dissection, and rupture, which may be fatal.
Diagnosis is by imaging tests (eg, ultrasonography, CT angiography, magnetic resonance
Diagnosis of an aortic aneurysm?
angiography, aortography).
What is the gold standard diagnostic modality of a AAA? Angiography is GOLD STANDARD for evaluation of AAA
MC location of AAA? Infrarenal aorta
What size should you refer AAA to vascular surgeon? > 4.5 cm
No further testing if aorta < 3.0 cm diameter
ÏRepeat US yearly if aorta 3.0 - 4.4 cm
How do you follow an AAA? ÏRepeat US every 6 months if aorta 4.5 - 5.0 cm (Referral to vascular surgery at this stage)
ÏRepeat US every 3 months if aorta 5-5.4 com
Ï> 5.5 or > 0.5 cm expansion in 6 months - Immediate surgical repair (even if asymptomatic)
What is the screening recommendation for AAA? Ultrasound, if male >65 and ever a smoker
Tx of ruptured AAA? Emergent surgery
A patient presents with sudden-onset chest and back pain. Further work-up reveals an Suspect an acute aortic dissection when chest or back pain is associated with ischemic and/or
ischemic right leg. What is your diagnosis? neurologic deficits
1/9
, An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's
What is an aortic dissection?
main artery (aorta)
Interscapular back pain. Many patients will complain of a "ripping" sensation in their back as
What is the most common symptom of aortic dissection?
the dissection is taking place.
Blood pressure and pulse ditterences between arms and/or legs, cardiac tamponade, and
What physical findings suggest an acute aortic dissection?
aortic insuflciency murmur
Proximal ascending aorta (60%)
ÏTwenty percent of aortic dissections are found between the origin of the left subclavian and
Where do aortic dissections most often occur?
the ligamentum arteriosum in the descending aorta
Ï10% are found in the aortic arch or the abdominal aorta
Uncontrolled hypertension is the most important risk factor. Additional risk factors include
Risk factors for aortic dissection?
trauma, cocaine, Marfans, Turners
Widening of the superior mediastinum, a hazy or enlarged aortic knob, an irregular aortic
What may an x-ray of a patient with an aortic dissection reveal? contour, separation of the intimal calcification from the outer aortic contour that is greater
than 5 mm, a displaced trachea to the right, and cardiomegaly.
What is the gold standard for evaluation of aortic dissection? MRI Angiography is the gold standard for evaluation
ÏStanford type A: Always involves the ascending aorta but could include the descending aorta
Describe the Stanford classification of aortic dissections
ÏStanford type B: Involves the descending aorta only
Use the mnemonic "bad"
Type I: both aorta
Debakey classification of thoracic aortic dissection?
Type II: ascending aorta
Type III: descending
Patients with Stanford type B and (type III) are eligible for medical, rather than, surgical
What dissections can be treated medically? treatment. Surgical treatment may be required for those with uncontrollable pain, aortic
bleeding, hemodynamic instability, increasing hematoma size, or an impending rupture.
ÏLower Blood pressure
Management of aortic dissections based on Stanford classification? ÏType A (proximal aortic dissection) requires surgical management
ÏType B (distal aortic dissection) - medical management initially, surgery only if needed
Which drugs should be administered to lower the BP in a patient with thoracic aortic Sodium nitroprusside. A beta-blocker should also be used to reduce the dp/dt (propagation
dissection? speed)
Injury to the tunica intima (innermost layer of the aorta) allows blood to flow between the
Why does an aortic dissection lead to profound shock? layers of the aortic wall, forcing the layers apart. Blood flows into a false lumen and not
systemic circulation.
20% of afflicted individuals die within 24 hours, 60% within 2 weeks, and 90% within 3 months.
What is the prognosis of an untreated aortic dissection? With surgical treatment, the 10-year survival rate is 40%. Redissection occurs in 25% of these
patients within 10 years of the original episode
Acute occlusion of an artery, usually by embolization; other causes include acute thrombosis
What is acute arterial occlusion?
of an atheromatous lesion, vascular trauma
The "six P's": Pain, Paralysis Pallor, Paresthesia, Polar (some say Poikilothermia—you pick),
What are the classic signs/ symptoms of acute arterial occlusion?
and Pulselessness (You must know these!)
2/9
