" وقل ربي زدني علما ً "
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MANIFESTATIONS OF MANIFESTATIONS OF VASCULAR DISEASESVASCULAR DISEASESMANIFESTATIONS OF MANIFESTATIONS OF VASCULAR DISEASESVASCULAR DISEASES
Prof. Hasan Ali Al Zahrani, FRCSProf. Hasan Ali Al Zahrani, FRCS
Professor of Surgery,Professor of Surgery,
Consultant Vascular SurgeonConsultant Vascular Surgeon
King Abdulaziz University, JeddahKing Abdulaziz University, Jeddah(www.profzahrani.com)(www.profzahrani.com)
Arterial Problems1. Aneurysms : - AAA - peripheral2. Limb ischaemia : - acute - chronic3. Vasculitis : - Types - Thromboangitis obliterans4. Carotid artery disease :5. D.M. foot :
Venous Problems
6. Varicose veins
7. D.V.T. & postphlebitic limb
8. Leg ulcers
Others
9. Vascular malformations
10. Angioaccess
11. Thoracic Outlet Syndrome
12. Vascular Trauma
Aneurysms
Definition :Localized dilatation of an artery
or vein• The commonest is AAA• Rare in veins• Usually due to ATO
Symptoms :
• Most are asymptomatic• Intermittent claudication
(if there is occlusive disease)• Trash foot or blue toes syndrome
(if embolizing)• Severe abdominal and/or back pain
(if leaking)• Shock (if ruptures)
Signs :
• Pulsating epigastric mass – AAA• Pulsating iliac mass - ? Iliac• Examine other arteries 5-10%
associated aneurysms• Abd. tenderness• Shock
Acute Limb Ischaemia
• Sudden cessation of blood flow to lower or less frequently upper limb which is usually due to embolism or trauma and less frequently due to thrombosis.
A.L.I.Causes :1. Embolism : a. Cardiac : very common - A.F. - M.I. in I.H.D. - Rh. H. D - Others b. Non-cardiac : - atheromatous plaques - aneurysm - trauma
A.L.I.
2. Thrombosis : a. Acute or chronic (? I.C.) b. Aneurysms c. Severe D.V.T. (P.C.D.)
A.L.I.
Symptoms & Signs :
• The 5 P’s• Coldness• Poor capillary refilling• Rigor (late signs)• Examine other pulses• Heart examination
A.L.I.
Investigation :
• C.W. Doppler• Duplex scan• Arteriography (in selected cases)• ECG, CXR, Echo
A.L.I.
Management :
• Aim to minimize the time lag to less than 8 hours
• Establish the underlying cause • Heparin infusion• Surgical embolectomy• Fibrinolytic therapy• ? Primary amputation
Chronic Limb Ischaemia (C.L.I.)
• Affects usually the lower limbs• Usually due to atherosclerosis• Common in D.M. patients• Symptoms and signs depend on the
site of occlusion.
Chronic Limb Ischaemia (C.L.I.)
Symptoms :
• Intermittent claudication :- cramping pain affecting usually the calf
muscles which comes with exercise and relieved by rest. (? Distance, radiation)
• Rest pain:- severe burning pain affecting the forefoot,
coming at rest and relieved by hanging the leg beside the bed
• Impotence :- Leriche’s Syndrome
Chronic Limb Ischaemia (C.L.I.)
Signs :
• Ulceration :- painful, no bleeding• Pallor, Buerger’s test, rubor or
dependency, capillary re-perfusion• Cyanosis, coldness, trophic changes• Examination of pulses• Listen for bruits
(C.L.I.)
Investigations :
• General including :- R.B.S., lipids, CXR, ECG
• Specific:-– A/B index, toe pressure– Duplex scan– MRA, C.T. angio,.– Angiogram
(C.L.I.)
Indications for surgery :
• Disabling I.C.• Critical ischaemia:- I.R.P., ulcer• Impotence• ? Progressive disease
(C.L.I.)
Medical:- Anti-plateletsControl D.M., hyperlip., high B.P.Stop smokingReduce weight and diet? Pentoxyfylline
Endovascular and surgical :- P.T.A. stentingbypassendartrectomyamputation
Vasculitis
Definition : A group of vascular
inflammatorydisorders sharing immune-mediatedreactions but with distinctive clinicalpicture, e.g.• Thromboangitis obliterans• P.A.N., G.C.A., …etc.
Buerger’s Disease (T.A.O.) : -
Vasculitis of small and medium-sizedveins and arteries affecting mainly
youngand middle-aged males who smoke heavily.
Its aetiology in unknown.
Buerger’s Disease (cont) : -
Management :• Diagnosis (including diff. Diag.)• Stop smoking• Vasodilators• Sympathectomy• Bypass• Amputation
Carotid Artery Disease (CAD)
Symptoms :• TIA• PRIND• Amurosis fugax• Stroke• Blindness
Signs :• Carotid bruit• Neurological deficits
C A D
Diagnosis :• Duplex scan• MRA• CT• Carotid angio
C A D
Management :1. Medical : - Antiplatelets
- Anticoagulants- Control risk factors
2. Carotid Endartrectomy3. ?? Angioplasty
D M F
• High incidence of D.M. in S.A.
• The most common indication for amputation
• Factors :– Ischaemia : 40%
– Neuropathy : 60%
– Infection : 90%
D M F
Diagnosis :-• For Infection :-
- CBC, culture, x-ray of foot
• For Ischaemia :-
- Toe pressure, Duplex scan, Angio
• For Neuropathy:-
- EMG
D M FPrevention :-Management : -1. Medical :
- control of D.M. & hyperlipidaemia- antibiotics- Antiplatelets
2. Surgical :- Debridement + drainage- Vascular reconstructive procedure
- Skin grafting- Amputation
TThhaannk k YYoouu !!! !!!TThhaannk k YYoouu !!! !!!