What are the 4 likely etiologies of ascending aortic aneurysms?
Answer:
a. Cystic medial necrosis
b. Marfan syndrome
c. Ehlers-Danlos syndrome
d. Syphilis
Top 3 etiologies of aneurysms in the arch and descending aorta?
Answer:
a. Atherosclerosis
b. Rarely mycotic aneurysm
c. Trauma
Major complications of thoracic aortic aneurysms:
Answer:
a. Rupture
b. Acute dissection
What is Takayasu arteritis? What population is most commonly affected? Which vessels are most commonly effected? Treatment?
Answer:
a. Granulomatous (giant cell) inflammation of media and adventitia of large elastic arteries.
b. In Asian women. Female-to-male ratio of 10:1.
c. Most often affects thoracic aorta and its proximal branches and pulmonary arteries.
d. Initial treatment with high dose steroids, stenoses are typically managed wtih angioplasty and/or stenting.
Aortic infection is usually divided into which two (2) types based on the causative microorganism?
Answer:
a. Syphilitic
b. Mycotic (nonsyphilitic)
The most common organisms to cause mycotic nonsyphilitic aortitis? (3)
Answer:
a. Staphylococci
b. Streptococci
c. Salmonella
What is the most common complaint in symptomatic patients with PAVM (pulmonary arteriovenous malformations)?
Answer:
Epistaxis from hereditary hemorrhagic telangiectasia.
Describe the two main categorizations of Pulmonary Arteriovenous Malformations.
Answer:
a. Simple: One artery to one vein
b. Complex: Multiple feeding arteries and/or draining veins
Fibromuscular disease (FMD) has been described in which arteries?
Answer:
Upper extremity:
- Subclavian artery
- Axillary artery
- Brachial artery
Describe thoracic outlet syndrome? What is the most common etiology?
Answer:
a. Compression syndrome of upper limb neurovascular bundle at the level of scalene muscles and first rib.
b. 70% with arterial injury have a cervical rib.
What is popliteal entrapment?
Answer:
Popliteal artery and or vein deviate around medial head of gastrocnemius.
What is adventitial cystic disease? How does it present? What vasculature is most commonly affected?
Answer:
a. Mucin collects in adventitial layer
b. May lead to narrowing or obstruction
c. Most commonly in popliteal artery
What is arteriomegaly. Where does it manifest?
Answer:
a. Unusual manifestation of aneurysmal disease
b. Diffuse, generalized dilation of aortoiliac and femoral vessels
What is the most common pathogen of mycotic aneurysms or pseudoaneurysms in the abdominal aorta?
Answer:
Salmonella species, in up to 74%.
What are the two most common etiologies for renal artery occlusive disease? Others? (5)
Answer:
a. Two most common:
- Atherosclerosis
- Fibromuscular dysplasia (FMD)
b. Others (5):
- Dissection
- Vasospasm
- Vasculitis
Coarctation syndromes.
Neurofibromatosis.
What are the two main potential mechanisms by which neurofibromatosis typically leads to renal artery stenosis? (2)
Answer:
a. Extrinsic compression of renal artery by neurofibromata.
b. Disorganized intimal and medial proliferation at renal artery orifice or proximal renal artery.
Hypertension secondary to neurofibromatosis is seen mainly in what patient population?
Answer:
Children.
Renal artery aneurysms, outside of trauma, are basically of which two types?
Answer:
a. Extrarenal:
- Atherosclerosis
- FMD
b. Intrarenal:
- Polyarteritis nodosa (PAN, small and multiple)
What is hypoplastic aortic syndrome? Usual patient population?
Answer:
a. Congenital long segment narrowing of aorta.
b. Usually seen in young females.
What is polyarteritis nodosa (PAN)? Which organs are typically affected? What are the classic radiographic findings?
Answer:
a. A rare necrotizing vasculitis that affects small and medium-sized arteries of multiple organs.
b. Most commonly:
- kidney (85%)
- Liver (65%)
c. Multiple, small, saccular microaneurysms, occlusions, and irregular stenoses throughout abdominal viscera
What are some potential causes of SVC syndrome?
Answer:
a. Bronchogenic carcinoma (up to 82%)
b. SVC stenosis and or thrombosis
c. Extrinsic compression:
- Granulomas (histoplasmosis and tuberculosis)
- Lymphoma
d. Intrinsic:
- Intravascular foreign bodies (pacemaker leads, central venous catheters), Venous stenoses caused by chronic dialysis and venous hypertension
What is May-Thurner syndrome?
Answer:
a. Compression of left iliac vein by crossing right iliac artery.
b. This is a normal anatomic variant.
c. Arterial pressure on the iliac vein results in wall thickening, narrowing, and thrombosis.
What is Budd-Chiari syndrome?
Answer:
a. Occlusion of hepatic veins
b. Result of hepatic venous or IVC outflow obstruction
