Download Arterial Disorders

Introduction:
Arterial disease includes:
 Acute arterial occlusion
 Chronic arterial occlusion
 Aneurysms
Chronic Arterial Occlusion:
 Causes: atherosclerosis
 Risk factors:
1.
2.
3.
4.
5.
6.
7.
Hyperlipidemia
Hypertension
Diabetes melitus
Obesity and decrease physical activity
Smoking
Male sex
Advanced age
Pathogenesis:
Clinical presentation:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Intermittent claudication
Rest pain
Coldness and color changes
Ulceration and gangrene
Reduced sensation, numbness, parasthesia
Motor weakness
Absent or diminished pulses
Arterial briut
Beurger’s angle
Investigations:
1. Doppler ultrasound
2. Duplex ultrasound.
3. Angiography (gold standard)
4. CT angiography and MRA.
Non-surgical treatment:
1. Stop smoking
2. Control of blood sugar
3. Reduce blood lipid
4. Reduce weight
5. Regular exercise to the limit of claudication
6. Drugs:
A. Antiplatelets e.g.; aspirin, clopidogrel.
B. Vasodilators e.g.; tolazoline, calcium canal blo
ckers, pentoxifylline,
Percutaneous transluminal angioplasty:
 Advantages:
 simple procedure
 under local anesthesia
 less cost,
 Shorter hospital stay
 Lower mortality rate
 Complications:
 Hematoma
 Arterial dissection
 Aneurysm
 Renal failure
 Allergic manifestations
Surgical treatment:
1. Bypass surgery
2. Surgical endarterectomy
3. Sympathectomy
4. Endovascular procedures
5. Amputation
Surgical bypass:
Endarterectomy:
Beurger's disease
(ThromboangitisObliterans):
 Progressive inflammatory segmental disease of small
& medium sized arteries.
 Upper and lower limb arteries and veins
 Treatment:
 Pain relieve
 Abstinence from smoking
 Drugs: steroids, anticoagulants and vasodilators
 Surgery.
Aneurysms:
Classification of aneurysms:
I. Wall:
1.
2.
True aneurysms
False aneurysms
II. Morphology:
1.
2.
3.
Fusiform
Saccular
Dissecting
III. Etiology:
1.
2.
3.
4.
5.
Atherosclerotic
Mycotic
Collagen vascular disease
Traumatic
Post stenotic
Clinical presentation:
 Asymtomatic
 Symptomatic
 Pressure on nearby structures
 Aneurysm thrombosis leading to ischemia
 Aneurysm embolization
 Aneurysm rupture.
 O/E: palpable, expansile mass
Treatment:
1. Aneurysm excision with graft interposition
2. Aneurysm repair
3. Aneurysm excision with resection of supplying
tissue
4. Aneurysm excision without arterial reconstruction
5. Endovascular aneurysm repair
Graft interposition
Endovascular repair
Acute arterial occlusion:
 Causes:
 Embolism
 Thrombosis of an atheromatous plague
 Arterial trauma.
Embolic arterial occlusion:
 What is an embolus?
 What is the most common source of an
embolus?
 What does an embolus cause?
Clinical presentation:
 Depending on the site of obstruction:
 Limbs: (6P); pain, pallor, paresis, purchasing
cold, pulselessness , and paraesthesia.
 Brain: stroke
 Retina: amaurosis fugax
 Intestine: gangrene of corresponding loop of
bowel
 Spleen: splenic infarction and left
hypochondrial pain
 Kidney: loin pain and hematuria
Diagnosis & treatment:
Diagnosed clinically
1. Heparin
2. Relieve pain
3. Emergency embolectomy
Acute arterial thrombosis:
 Sudden occlusion of an already diseased artery
 Acute on chronic ischemia
 Similar presentation to emboli but less severe. Why?
 Arterial mapping mandatory
 Embolectomy may be not enough
Arterial Trauma
 Causes:
 Penetrating injury
 Blunt injury
 Deceleration injury
Patterns of injury:
Clinical presentation:
 Signs of arterial injury include:
Pulsatile bleeding or pulsatile or expanding hematoma
2. Bruit or thrill
3. End organ ischemia
 Suggestive signs include:
1. Unexplained shock
2. Trauma near a known course of a major artery
3. A stable hematoma
4. Injury to a nerve known to share a common course with a
major artery
5. History of pulsatile bleeding from a wound
1.
Treatment:
1. ABC
2. Control of hemorrhage
3. Operative treatment
Complications of vascular trauma:
1. Anastomosis dehiscence
2. Anastomosis site thrombosis
3. Pseudoaneurysm formation
4. Traumatic arterio-venous fistula formation
5. Compartment syndrome
6. Reperfusion injury