Download Basic principles of vascular surgery

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

page
1
page
2
page
3
page
4
page
5
page
6
page
7
page
8
page
9
page
10
page
11
page
12
page
13
page
14
page
15
page
16
page
17
page
18
page
19
page
20
page
21
Document related concepts
no text concepts found
Transcript 
Basic principles of vascular
surgery
Anatomy
 Physiology
 Pathology
 Pathophysiology
Clinical presentation.History, physical
exam.
investigation
management

physiology


Haemostasis
vasoconstriction
platelet
aggregation
 Coagulation intrinsic, extrinsic
 Fibrinolysis
 Renin angiotensin system
Vascular pathology






Atherosclerosis:
formation,flow
placque
effect, fate of the
placque
Risk factors
Clinical sequelae : stenosis, occlusion,
thrombosis,
embolisation,
aneurysm
Vascular pathology
1-Trauma:RTA,falls, stabs, gun shot,
sharps
Iatrogenic
DRUG ADDICT
2-Inflammatory: (VASCULITIS)
Takayassaue, Kawasaki, Beurger
Connective tissue (SLE, polyart. Nod.,
Rh. Art.,)
3-Spasmodic Reynauds dis.,
phenomenon
4-Conginetal malformation : venous,
arterial
AVM
symptomatology
Chief complaint, history of the
present illness



Peripheral vascular symptoms
atherosclerosis risk factors
Review of important systems
Peripheral vascular
symptoms
Acute ischaemia
 Chronic ischaemia
 Infection
 Neuropathy
 Foot trauma/injury
 Syndromes amaurosis fugax,
dysphagia lusoria, Leriche , TIA, CVA

Atherosclerosis risk factors

Nonmodifiable age , gender , family

Modifiable
stress
D.M., Hypertension, Smoking
Dyslipidaemia, obesity,
Review of systems

Cardiac

Cerebral

Renal

Gastrointestinal
Renovascular hypertension
10-20%of secondary hypertension
 Uncontrolled despite 2-3 meds
 Flash pul.oedema
 Hypokalaemia
 Captopril test
 Doppler US., MRA
 Angioplasty

Examination


Pulse, B.P., Edema
Local inspection
Colour elevation,
dependency
Skin trophic changes
Driness, hair, nails,
wasting
venous filling
Ulcers , Gangrene
Ulcers def., types
Gangrene
infarction
Necrosis
Examination

Palpation
temp. pulses, cap. Filling

Auscultation carotid , femoral
Investigation
Bood work, ECG, CXR
 Non invasive vascular lab
ankle/brachial index
exercise test , toe pressure
doppler ultrasound
Invasive
angiography, CT, MRA

Medical Management
1-Risk factors control
2-improve blood flow
aspirin, pentoxyphylline
clopidogrel, anticoagul.
Aspirin mechanism of action
Phosphlipids---arachidonic acid----(cyclooxygena)--endoperoxides:
In plt. --------thromboxane(throm.synth)
ATP-----ADP(plt
aggreg.+vasocons)
In blood vessel endoth.
Endoperox.----prostacyclin(stimulate adenyl
cyclase)
ATP------cAMP(plt
sgreg.+vasodil)
-----5AMP
Surgical management
For rest pain, ulcers, gangrene
 Embolectomy , thrombectomy,
 Vascular reconstruction
Endart.,repair,
resection+interposition,Bypass
Using saphenous vein (reverse/insitu)or
PTFE
 Amputation toe, transmet.,
symes,BK,AK

Related documents