الجامعة السورية الخاصة

1. الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD – FRCS www.surgi-guide.com 2nd lecture M.A.Kubtan

2. Acute Arterial Occlusion Definition : Is sudden occlusion of an artery commonly caused by Emboli , or Thrombus . M.A.Kubtan

3. Definition • Embolus : Is an abnormal mass of undissolved material which is transported in the circulation from one part to another . • Thrombus: Is thrombotic lesion occurs on a plaque of pre-existing atheroma ending with complete acute occlusion of the artery . M.A.Kubtan

4. Classification of Embolism • Thrombi and clot may be bland or infected. • Gas : Air and Nitrogen . • Fat . • Tumour . • Miscellaneous . M.A.Kubtan

5. Embolic Occlusion • It is often a thrombus that has become detached from the Lt Atrium in cardiac arrhythemia ( atrialfibrellation , or mural thrombus following myocardial infarction . • Less common are aneurysm and thrombi formed on atheromatous plaques causing artery to artery embolism . M.A.Kubtan

6. Clinical features of Arterial Occlusion It is an emergency and requires immediate treatment • Leg >>>> pain , pallor >>>> parisis >>>> pulslessness ,paraesthesia ( anaesthesia ) . • The limb is cold and toes cannot be moved in contrast with venous occlusion when muscle function is not affected . • The diagnosis can be made on clinical bases . • Symptoms may progress to complete loss of function , coldness and mottling. M.A.Kubtan

7. Types of embolism and complications • Compartment syndrome . • Intra-arterial thrombosis . • Mesenteric artery occlusion . • Air embolism . • Bacterial infected clot embolism . • Malignant cells ( Hypernephroma , Cardiac myxoma ) • Fat embolism . • Therapeutic embolisation. M.A.Kubtan

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11. Treatment • Total heparinisation ( Intravenous Heparin 5000 U ) . • Relief of pain since it is sever and constant . • Thrombolysis when indicated . • Embolectomy . M.A.Kubtan

12. Abdominal Aortic Thrombosis M.A.Kubtan

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14. Fogarty catheter for removal of Embolus M.A.Kubtan

15. Removal of organized thrombus M.A.Kubtan

16. Saddle Aortic Thrombosis M.A.Kubtan

17. Thrombus removed from SFA & POP A M.A.Kubtan

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19. GANGRENE • Implies death of macroscopic portion of tissue • It is often affects distal part of limb because of arterial obstruction . • Gas gangrene caused by anaerobic infection . M.A.Kubtan

20. Clinical features • Absent arterial pulsation . • Absent venous return. • Absent capillary response to pressure . • Absent sensation . • Absent warmth . • Absent function . • Changes in colour : Pallor , duscky grey ,mottled , purple >>> dark-brown , greenish-black ,black. M.A.Kubtan

21. Types of gangrene • Dry gangrene . • Moist gangrene the affected part becomes swollen ,and discoloured . Crepitus may be palpated .this condition is quite common in feet of diabetics. M.A.Kubtan

22. Specific varaieties of gangree • Diabetic gangrene . • Bedsores . • Drug abuse .Injecting of drugs into arteries . • Frost bite . • Venous gangrene M.A.Kubtan

23. Frostbite of the foot note the clear demarcation line M.A.Kubtan

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26. Treatment of gangrene • According to stage . • In diabetic gangrene : Oxygenation , Antibiotics , • Extensive debridement. • Amputation . M.A.Kubtan