intima - endothelial cells, internal elastic lamina
media - collagen, elastin, smooth muscle cells arranged in bundles oriented along the lines of greatest tensions => carries most of tensile load
adventitia - fibrous connective tissue, vasa vasorum for nutrient supply, nerve fibers that regulate cell tone
endothelium - interact with smooth muscle cells to regulate luminal diameter
Blood Flow Control
local control
myogenic theory - vascular smooth muscle contracts and relaxes in response to varying pressure
metabolic theory - tissue blood flow parallels metabolic activity
nervous system control
sympathetic nervous system has primary neural control of vascular muscle tone
local humoral control
humoral substances affect vascular smooth muscle tone
flow related control
blood flow regulates arterial diameter
- Look at arterial inflow vs. venous outflow
intimal flap
profundaplasty
blind endarterectomy
examine pt ABI before pelvic surgery
cardiac workup(+)
plavix
For rectal cancer, APR or sigmoid LAR
what vessels are removed?
Salvage IMA, don't want to get into lumbar a.
end to end(EE) vs. end to side(ES) (pick end to side)
end to end take IMA out, used as collaterals to pelvis
reactive hyperemia
angioneedle
fem fem vs ilio fem
fem fem fem pop?
cardiac ivis, 014 ivis
total abdominal colectomy
L side verticulitis
Endoleak
stress test
coronary stent
rectal perineal mass
femoral pulse
EIA dissection
paresthesias
stenosis
Stille
TOS operation?
impending rupture sign?
radiographic sign in non-contrast CT that is often misinterpreted. Crescenteric area of high attenuation outside lumen
in aneurysm, increased risk of rupture
neurothrombus
vascular disease
virectomy
laser surgery
rest pain
AV fistula
hyperstenosis
hypodynamic
PTA(percutaneous transluminal angioplasty)
bivon
I-cast?
distal anastomosis wire foverty
peripheral vascular disease
nonhealing BK
--------------------------------------------------------------------------
Main Entry: dys·pha·sia
Pronunciation: dis-
f
-zh(
-)
Function: noun
: loss of or deficiency in the power to use or understand language as a result of injury to or disease of the brain -- compare DYSARTHRIA
--------------------------------------------------------------------------
Main Entry: peri-
Function: prefix
1 : near : around <perimenopausal>
2 : enclosing : surrounding <perineurium>
--------------------------------------------------------------------------
intimal flap
The initiating event in an aortic dissection is a tear in the intimal lining of the aorta. Due to the high pressures in the aorta, blood enters the media at the point of the tear. The force of the blood entering the media causes the tear to extend. It may extend proximally (closer to the heart) or distally (away from the heart) or both. The blood will travel through the media, creating a false lumen (the true lumen is the normal conduit of blood in the aorta). Separating the false lumen from the true lumen is a layer of intimal tissue. This tissue is known as the intimal flap.
--------------------------------------------------------------------------
Profundaplasty: technique of opening a narrowing in an artery of the leg
--------------------------------------------------------------------------
Plavix / Clopidogrel (IPA: [kloʊˈpidoʊgrɛl]) is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease.
| Bioavailability | >50% |
| Metabolism | hepatic |
| Half life | 7–8 hours (inactive metabolite) |
| Excretion | 50% renal 46% biliary |
--------------------------------------------------------------------------
End to End(EE) vs. End to Side(ES) Anastomosis
As the application of microsurgery grows, the desirability
of performing an end-to-end (EE) vs. an end-to-side (ES)
anastomosis continues to be debated. From a technical
standpoint, the end-to-end method is an easier procedure to
perform. The end-to-side method is preferred when distal
flow of the recipient artery must be maintained, or when
there is a significant size discrepancy between the two vessels.
Some authors suggest that end-to-side is superior.
--------------------------------------------------------------------------
Hyperaemia (AmE hyperemia) is the medical condition in which blood congests in a part of the body. The condition may be subdivided into active hyperaemia, in which blood collects in an organ due to increased blood flow, and passive hyperaemia, in which blood collects in an organ due to an obstruction in the outflowing veins.
Active hyperemia is also a term used to describe dilation of arteriolar smooth muscle to increase blood flow in response to an increase in metabolism. Reactive hyperemia is the same but in response to a profound increase in blood flow to an organ after being occluded. There will be a shortage of oxygen and a build-up of metabolic waste.
--------------------------------------------------------------------------
ENDOLEAK TYPES
Exclusion of the aneurysm sac is the main goal of the stent-graft treatment, and clinical success is defined by the "total exclusion" of the aneurysm. However, at times, failure of the stent-graft to totally exclude blood flow to the aneurysm sac may occur. As a matter of fact, endoleak is the major cause of complications, and thus failure in endoluminal treatment of AAA. When an endoleak occurs, it causes continued pressurization of the aneurysm sac and may leave the patient at risk of an AAA rupture.
Endoleak is defined as a persistent blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or adjacent vascular segment being treated by the device. Endoleaks are due to incomplete sealing, or exclusion of the aneurysm sac, and thus cause reflux of blood flow into the sac. Four types of endoleaks are currently known and labeled.
Type I endoleak: blood flow into the aneurysm sac due to incomplete seal or ineffective seal at the end of the graft. This type of endoleak usually occurs in the early course of treatment, but may also occur later.
Type II endoleak: blood flow into the aneurysm sac due to opposing blood flow from collateral vessels. In some circumstance when there are two or more patent vessels a situation of inflow and outflow develops creating an actively blood flow within channel created within the aneurysm sac.
Type III endoleak: blood flow into the aneurysm sac due to inadequate or ineffective sealing of overlapping graft joints or rupture of the graft fabric. Again, this endoleak usually occur early after treatment, due to technical problems, or later due to device breakdown.
Type IV endoleak: blood flow into the aneurysm sac due to the porosity of the graft fabric, causing blood to pass through from the graft and into the aneurysm sac.
For the present, as a result of the major complications that endoleaks cause, one may conclude that endovascular treatment of AAA is still an evolving field. It is to be hoped in the future that better patient selection and improved devices will result from proper recording and appropriate analysis of clinical data.
Anteroposterior image from a conventional angiogramreveals an endoleak at the proximal attachment site of a bifurcated Talent endograft(top)
Translumbar embolization of a type II endoleak, 1 yr after endovascular aneurysm repair. Accessed via a right translumbar approach(bottom)--------------------------------------------------------------------------
Main Entry: stress test
Function: noun
: an electrocardiographic test of heart function before, during, and after a controlled period of increasingly strenuous exercise (as on a treadmill)
--------------------------------------------------------------------------
EIA(external iliac artery) dissection
dissection refers to a tear in the wall of a blood vessel
--------------------------------------------------------------------------
Paresthesia or paraesthesia (paraesthesia in British English) is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep.
Transient occurance
Transient paresthesia is the temporary sensation of tingling, pricking, or numbness of the skin -- "pins and needles." It is usually felt in the extremities (hands, arms, legs, or feet), but can also occur in other parts of the body. This temporary sensation is usually caused by inadvertent pressure placed on a superficial nerve. The sensation gradually goes away once the pressure is relieved.
[edit] Chronic condition
Chronic paresthesia indicates a problem with the functioning of nerve cells, or neurons. This malfunction, which is especially common in older individuals, is often the result of poor circulation in the limbs (such as in peripheral vascular disease), or may be caused by atherosclerosis—the build up of plaque on artery walls. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia is also a symptom of vitamin deficiency and malnutrition, as well as metabolic disorders like diabetes and hypothyroidism.
--------------------------------------------------------------------------
Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). For the most part, these disorders are produced by positional compression of the subclavian artery and vein, the vertebral artery, and the nerve cords of the brachial plexus. The disorders are complex, somewhat confusing, and poorly defined, each with various signs and symptoms not only arising from the upper extremity but also from the chest, neck and head. The chest pain can mimick anginal pain.
Definition Return to top
Thoracic outlet syndrome is a condition characterized by pain in the neck and shoulder, numbness/tingling of the fingers, and weakening of the grip.
Causes, incidence, and risk factors Return to top
Thoracic outlet syndrome is a rare condition caused by compression of blood vessels and nerves in the area of the clavicle (collar bone). This compression usually is caused by the presence of an extra cervical rib (above the first rib) or an abnormal tight fibrous band connecting the spinal vertebra to the rib.
People with long necks and droopy shoulders may be predisposed to develop this condition because of extra pressure on their nerves and blood vessels.
Symptoms Return to top
The following symptoms may indicate thoracic outlet syndrome:
- Discomfort in the last 3 fingers (middle, ring, and pinky) and inner forearm
- Numbness
- Pain
- Tingling
- Pain and tingling in the neck and shoulders (may be worsened by carrying something heavy, such as a suitcase)
- Weakness and wasting of the muscles of the hand
Signs and tests Return to top
Upon lifting, the arm may appear pale due to compression of the blood vessels. The arm may be smaller on the side of the symptoms, as this is often a congenital anomaly (present since birth).
Treatment Return to top
The syndrome is generally treated conservatively, with physical therapy to strengthen the shoulder muscles, improve range of motion, and promote better posture, as well as with analgesics or other pain medications.
The surgery to release the nerves in the region of the thoracic outlet (Brachial Plexus Decompression) is not a simple procedure, and it should be avoided if at all possible. It is only recommended if your problem is significant and there is little improvement in response to the non-operative measures described above.
Surgical approach is usually supraclavicular, allowing for direct visualisation of the brachial plexus. The muscles and fibrous bands compressing the nerves can be released. If necessary, a neurolysis of the brachial plexus can be performed.
--------------------------------------------------------------------------impending rupture sign
--------------------------------------------------------------------------
rest pain
Constant pain (particularly at night) found in the toes or foot that is caused by poor blood flow.
--------------------------------------------------------------------------
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. It is also sometimes called a "stricture" (as in urethral stricture).
[edit] Causes
- atherosclerosis causes stenotic lesions in arteries.
- birth defects
- ischaemia
- infection
- neoplasm
- inflammation
[edit] Types
The resulting syndrome depends on the structure affected. Examples of syndromes that may be caused by various stenotic lesions include:
- Intermittent claudication (peripheral artery stenosis)
- Angina (coronary artery stenosis)
- Obstructive jaundice (biliary tract stenosis)
- Carotid artery stenosis (strokes and transient ischaemic episodes)
- Pyloric stenosis (gastric outflow obstruction)
- Renal artery stenosis
- Bowel obstruction
- Phimosis
- Hydrocephalus
- Stenosing tenosynovitis
- Spinal stenosis
- Subglottic Stenosis (SGS)
--------------------------------------------------------------------------
Peripheral Vascular Disease
In medicine, peripheral artery occlusive disease (PAOD, also known as peripheral vascular disease or PVD) is a collator for all diseases caused by the obstruction of large peripheral arteries, which can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. It causes either acute or chronic ischemia.
Classification
Peripheral artery occlusive disease is commonly divided in the Fontaine stages:
- I: mild pain on walking ("claudication")
- II: severe pain on walking relatively shorter distances (intermittent claudication)
- III: pain while resting
- IV: loss of sensation to the lower part of the extremity
- V: tissue loss (gangrene)
[edit] Symptoms
- Claudication - pain, weakness, or cramping in muscles due to decreased blood flow
- Sores, wounds, or ulcers that heal slowly or not at all
- Noticeable change in color (blueness or paleness) or temperature (coolness) when compared to the other limb
- Diminished hair and nail growth on affected limb and digits
