1 / 45

ARTERIAL DISEASES

ARTERIAL DISEASES. Objectives: TO UNDERSTAND THE NATURE OF OCCLUSIVE ARTERIAL DISEASE AND ITS ASSOCIATED SYMPYOMS AND SIGNS TO ABLE TO ASSESS ACUTE AND CHRONIC ARTERIAL INSUFFICIENCY AND KNOW TREATMENT OPTIONS. TO KNOW ABOUT GANGRENE AND ITS MANAGEMENT

lorna
Download Presentation

ARTERIAL DISEASES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ARTERIAL DISEASES Objectives: TO UNDERSTAND THE NATURE OF OCCLUSIVE ARTERIAL DISEASE AND ITS ASSOCIATED SYMPYOMS AND SIGNS TO ABLE TO ASSESS ACUTE AND CHRONIC ARTERIAL INSUFFICIENCY AND KNOW TREATMENT OPTIONS. TO KNOW ABOUT GANGRENE AND ITS MANAGEMENT TO KNOW OTHER ARTERIAL DISEASES LIKE ANEURYSMS, ARTERITIS AND VASOSPASTIC DISEASES & AVFistula

  2. Arterial Occlusion

  3. Occlusive arterial disease Types • Acute arterial occlusion • Chronic arterial occlusion

  4. ACUTE ARTERIAL OCCLUSION CAUSES- • EMBOLIC • THROMBOTIC • Heart diseases-Atrialfibrillation,mural thrombus, Post MI • Rheumatic valvular heart diseases • Paradoxical embolism- venous thromboembolism due to patent foramen ovale • Arterio- arterial embolism- dislodgement of atheromatous plaques • Angiographic procedures • Accidental- intraarterial injection- Ergot,thiopental • Trauma.

  5. Embolism • Brain-MCA • Retina-Amaurosisfugax • Mesenteric vessel- • Spleen • Kidneys • Lungs-pulmonary embolism

  6. ACUTE ARTERIAL OCCLUSION-Embolism C/F FIVE Ps • PAIN • PARALYSIS • PALLOR • PULSELESSNESS • PARAESTHESIA

  7. Relation ship of symptoms to the site of obstruction Aorto-iliac obstruction Iliac obstruction Femoro-popliteal obstruction Distal obstruction ankle pulses absent • Caludication in both buttocks,thighs & calves. Femoral & distal pulses absent in both limbs. Impotence.bruit over aortoiliac region. • U/l claudication in thigh & calf buttocks. • Bruits over iliac region • U/L absence of femoral or distal pulses. • U/L claudication in calf. Femoral pulse palpable with absent u/l distal pulses • Femoral & Popliteal pulse palpable • claudication in calf & foot

  8. Arterial Stenosis Investigations: General- CBC,ESR, PLASMA -fibrinogen, protein, electrophoresis, Glucose- blood n urine. Lipid profile • Doppler -USG blood flow detection • Duplex imaging. • Echocardiography • Arteriography • DSA • ECG

  9. Hand held Doppler

  10. COLOUR DUPLEX

  11. ARTERIOGRAM

  12. DSA

  13. Angioscope

  14. Treatment. Embolic arterial occlusion is an emergency!!! • THROMBOLYSIS – Immediate -Intra Venous Heparin5000U to prevent distal and proximal extension of thrombus. Contraindications Recent stroke Active peptic ulcer Bleeding disorders Pregnancy • Hydration • EMBOLECTOMY • THROMBECTOMY.

  15. Fogarty catheterization- for removing proximal and distal extension of thrombus. • Postoperatively- heparin and oral anticoagulation • Intrarterial Thrombolysis • Only if ischemia is not so severe that immediate operation is mandatory, it is possible to treat thrombus or embolus by intra arterial thrombolysis • Agents-TPA-tissue plasminogen activator** • Streptokinase • Urokinase • Identify and treat the basic cause.

  16. SFA thrombolectomy

  17. Removed thrombus

  18. Arterial Catheters

  19. Chronic Arterial Insufficiency Etiology • Atherosclerosis • Buerger’s disease • Artritis • Arterisclerosis • Diabetes Risk Factors • Hypertension • Diabetes • Strong family history • Smoking • Lipid abnormalities

  20. Chronic Limb Ischemia • Ischemia of the lower limb may be minimal to critical • Also called Chronic arterial insufficiency or Peripheral Vascular disease-PVD. Clinical presentation- IntermittantClaudication-commonest complaint. Fatigue, aching or crampy pain occuring with exertion and relieved by rest, reproducible at the same distance. Claudication distance- distance at which the pain appears Rest pain Critical ischemia- severe ischemia with actual or potential tisssue loss.

  21. Signs of chronic ishemia • Loss of muscle mass/bulk • Loss of subcutaneous fat • Skin shiny • Loss of hair • Brittle nails • Gangrene and ulcers of foot.

  22. ???

  23. GANGRENE • Def: death, often with putrifaction of macroscopic portion of tissues. • VARIETIES ACCORDING TO THE CAUSE- Secondary: • Thrombus in atherosclerotic artery. • ATRIAL FIBRILLATION-embolus. • Arteritis from NEUROPATHY • BUERGERS DISEASE • RAYNAUDS DISEASE/ERGOTISM- causing arterial shutdown • INTRARTERIAL INJECTIONS- thiopentone & cytotoxic materials.

  24. GANGRENE Primary: • INFECTIVE- boils, carbuncles, gas gangrene, gangrene of scrotum (Fournier’s gangrene) • TRAUMATIC- crush, pressure sores & constriction grooves • PHYSICAL- burns, scalds,frostbite,chemical irradiation & electricity. • VENOUS- • C/F • Pulseless,painnless,funtionless, with colour change. • Lacks capillary refill and venous return. • Black,brown, greenish black.

  25. GANGRENE • CLINICAL TYPES- DRY & MOIST • DRY gangrene- • dessicatedtissues,part becomes dry and wrinkled. Wrinkled ,discolourd from disintegration of Hb. & greasy to touch. • MOISTgangrene: • when venous & arterial obstruction is present, when artery is suddenly occluded by a ligature or embolus & in diabetes.. • Infection & putrifaction is present. • Part is swollen& discoloured. • Crepitus may be present.

  26. GANGRENE SEPERATION OF GANGRENE- • SEPERATION BY DEMARCATION • SEPERATION WITHOUT DEMARCATION. • Vague DEMARCATION & skip lesions. TREATMENT OF GANGRENE- • GENERAL PRINCIPLES- limb saving attitude. • Cardiac failure • Atrial fibrillation anaemia. Nutritious diet. • Control of diabetes. • Analgesics. • LOCAL TREATMENT- • dry.protection of pressure areas. Cleanniess.

  27. VARIETIES OF GANGRENE DIABETIC GANGRENE- three factors- • Trophic changes from peripheral neuritis. • Atheroma of artries causing ischemia • Excess sugar –decreases resistance to infections esp. fungal infection • DIRACT TRAUMATIC GANGRENE • BEDSORES-(Decubitus Ulcers) 5 factors • Pressure • Injury • Anemia • Malnutrition • Moisture

  28. Pressure Sore

  29. Gangrene INDIRECT TRAUMATIC GANGRENE- Interference with blood vessels from pressure by a fractured bones / strangulation Thrombosis of an artery Ligation of an artery poor technique for digital anesthesia ERGOT- clavicepspurpurea. Fingers,nose & ears . Seen in migrane suffers.

  30. PHYSICAL AND CHEMICAL CAUSE OF GANGRENE . • FROST BITE- cold+wind. Damage to Vessel wall with transudation & edema. Pain initially later painless & gangrene • TRENCH FOOT-cold+ moist+ muscular inactivity. • Ill fitting boots. • I/V INJECTION OF THIOPENTONE • DRUG ABUSE • CHEMICAL GANGRENE- carbolic acid(phenol).

  31. Frost bite

  32. ANEURYSMS • ANEURYSMS- dilatation of a localised segment of the arterial system. • True- all three layers involved. • False- single layer of fibrinous tissue as the wall of the sac. • According to the shape -fusiform -Saccular -Dissecting Eti0logy-traumatic/atherosclerotic/syphilitic/collagen disease(Marfan,syndrome), mycotic(bacterial)

  33. ANEURYSMS • Symptoms- due to expansion, thrombosis, rupture or release of emboli. • Symptom relate to the vessel affected, the site supplies or the tissue compressed. Clinical features Intrinsic-expansile pulsation along the course of an artery. proximal compression decreases pulsations • Palpation- thrill • Auscultation-bruits?? Extrinsic- neighboring or distal structures are affected. • Nerve • Veins • Tubes-trachea ,esophagus

  34. D/D • Swelling under an artery- cervical rib(subclavian) • Swelling over an artery-pancreatic cyst • Pulsatile tumors-sarcoma,osteoclastoma & metastsis from hypernephroma. • abscess • serpentine artery- innominate,carotid.

  35. ANEURYSMS Abdominal aortic aneurysm- • Commonest large vessel aneurysm • 2% population • 95% atherosclerotic • 95% below the renal arteries • Symptomatic/asymptomatic • Symptoms-back pain, sudden – mild-sudden severe.

  36. ANEURYSMS Ruptured AAA- • Anterior • Posterior • Free bleeding into the peritoneal cavity(20%) • Retroperitoneal hematoma(80%) • Profound hypotension • Severe pain

  37. ANEURYSMS • Investigation: • USG abdomen • CT Chest & abdomen. • AORTOGRAM

  38. ANEURYSMS Procedure • Open surgical procedure • Endoluminal stent graft procedure. Complications: Respiratory H’ge Colonic ischemia Renal failure Infection of the graft. Sexual dysfunction Fistula formation. Spinal cord ischemia.

  39. Peripheral aneurysms • Popliteal aneurysms- most common • Femoral • Iliac • Ascending aorta & arch

  40. AVF: • Communication between an artery & vein. • Congenital • Acquired- trauma, penetrating wound or sharp blow, surgical for renal failure. • Structural effect- arterialized veins. Dilated tortuous veins • Physiological effect- Increased VR, Increased VP, Increased HR- Increased CO. • PP-HIGH • LVF • Cardiac failure • Cong Fistula- Overgrowth of limb. Persistent ulcer due to distal ischemia.

  41. ???

  42. AVF Clinical signs: • Pulsatile swelling • Thrill on palpation • Bruits on ausculatation • Dilated veins • Nicoladoni-Branham’s test- Decreased thrill, reduction in size and bradycardia on pressing the artery proximal to fistula Treatment • Embolization • Ligation of feeding artery??? • Surgery- Separation of artery & vein

  43. ARTERITIS • Thromboangitis obliterans/ Buerger’s disease • Small & medium sized arteries.Occlusive disease • Thrombophebitis of superficial/ deep veins. • Raynauds syndrome, male, young patients

  44. VASOSPASTIC CONDITIONS: Reynaud's syndrome: • Primary/ idiopathic form. • Secondary • Pallor- blanching • Blue- cyanosis • Redness-red engorgement. • Accompanied by pain. Treatment - conservative Tab. nicotinamide Secondary Reynaud's syndrome- • due to some other problem like-collagen disease, atherosclerosis, thoracic outlet syndrome, carpal tunnel syndrome

More Related