Basic principles of vascular surgery Anatomy Physiology Pathology Pathophysiology Clinical presentation.History, physical

exam. investigationmanagement

physiology Haemostasis vasoconstriction platelet

aggregation Coagulation intrinsic, extrinsic Fibrinolysis Renin angiotensin system

Vascular pathology Atherosclerosis: placque formation,flow

effect, fate of the placque Risk factors Clinical sequelae : stenosis, occlusion,

thrombosis, embolisation, aneurysm

Vascular pathology1-Trauma:RTA,falls, stabs, gun shot, sharps

Iatrogenic DRUG ADDICT2-Inflammatory: (VASCULITIS)

Takayassaue, Kawasaki, Beurger Connective tissue (SLE, polyart. Nod., Rh.

Art.,)3-Spasmodic Reynauds dis.,

phenomenon4-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 D.M., Hypertension, Smoking

Dyslipidaemia, obesity, stress

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., typesGangreneinfarction 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 ultrasoundInvasive angiography, CT, MRA

Medical Management

1-Risk factors control

2-improve blood flow aspirin, pentoxyphylline clopidogrel, anticoagul.

Aspirin mechanism of actionPhosphlipids---arachidonic acid----(cyclo-

oxygena)--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

(phosphodiesterase)

Surgical management For rest pain, ulcers, gangrene Embolectomy , thrombectomy, Vascular reconstructionEndart.,repair,

resection+interposition,BypassUsing saphenous vein (reverse/insitu)or

PTFE Amputation toe, transmet., symes,BK,AK