Acute arterial occlussion
-
Upload
pradeep-pande -
Category
Health & Medicine
-
view
62 -
download
0
Transcript of Acute arterial occlussion
![Page 1: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/1.jpg)
Diseases of Arterial SystemDiseases of Arterial System1. Introduction & History.2. Anatomy.3. Physiology.4. Acute Arterial Occlusion.5. Ischemia Chronic Arterial Occlusion.6. Buerger’s Disease7. Aneurysms.8. Vasospastic Diseases.
![Page 2: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/2.jpg)
Diseases of Arterial SystemDiseases of Arterial System
9.Gangrene, Pregangrene &Amputations.10.Vasular Problems of Upper Limbs11.Thoracic Outlet Syndrome.12.AV Fistula.13.Examination of Arterial System.14.Investigations of Arterial System.
![Page 3: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/3.jpg)
Acute Arterial Occlusion Acute Arterial Occlusion EtiologyEtiology
Intrinsic:• Embolism• Thrombosis
Extrinsic:• Trauma
![Page 4: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/4.jpg)
Embolism Embolism
-A body foreign to blood streamTo LLs is 10 times more common than ULNearly half of all emboli lodge at common
femoral bifurcation.
![Page 5: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/5.jpg)
Embolism:CausesEmbolism:Causes
1.Atrial Fibrillation with Mitral Stenosis -rough surface with dyskinesia.2.Myocardial Infarction: rough surface with
dyskinesia. 3.Left Atrial Myxoma.4.Congenital and Rheumatic Valvular
deformities.5.Prosthetic Heart Valves.
![Page 6: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/6.jpg)
Embolism:Causes Embolism:Causes
6.Arterio-arterial emboli:-ThrombusFibrinPlateletsCholesterol
![Page 7: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/7.jpg)
Embolism:CausesEmbolism:Causes
7.Iatrogenic: Catheter ComplicationsA.Tip may dislodge:mural thrombusvalvular vegetationsplaquesB.ThrombiC.Air
![Page 8: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/8.jpg)
Embolism:CausesEmbolism:Causes
8.Tumor9.BulletParadoxical Embolism
![Page 9: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/9.jpg)
EtiologyEtiology
Intrinsic:• Embolism• Thrombosis
Extrinsic:• Trauma
![Page 10: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/10.jpg)
ThrombosisThrombosis
1.Arteriosclerotic narrowing2.Atheromatous plaques3.Aneurysms4.Aortic dissection
![Page 11: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/11.jpg)
Arterial Thrombosis:CausesArterial Thrombosis:Causes
5.Arteriopathies:Buerger’s diseasePeriarteritis NodosaFibro muscular DysplasiaTakayasu’s Disease
![Page 12: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/12.jpg)
Arterial Thrombosis:CausesArterial Thrombosis:Causes
6.Hematologic:ThrombocytosisPolycythemiaDICErgotamine InfectionsMalignancies.
![Page 13: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/13.jpg)
EtiologyEtiology
Intrinsic:• Embolism• Thrombosis
Extrinsic:• Trauma
![Page 14: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/14.jpg)
Acute Arterial OcclusionAcute Arterial Occlusion Extrinsic Causes Extrinsic Causes
Trauma:To VesselTo surrounding soft tissues
![Page 15: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/15.jpg)
Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma
Direct TraumaLacerationTotal transectionContusionIatrogenic: Catheterization
Long bone fracture
![Page 16: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/16.jpg)
Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma
Long bone fracturesAngulationLacerationContusion
![Page 17: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/17.jpg)
Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma
Long bone fracturesSupracondylar FractureFracture HumerusFracture PatellaFracture Clavicle
![Page 18: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/18.jpg)
Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma
-Compartment Syndrome-Popliteat Artery entrapment (Between medial
head of Gastrocnemius and medial condyle of femur)
-Rarely tumors may invade the artery.-Electrocution
![Page 19: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/19.jpg)
Acute Arterial Occlusion Acute Arterial Occlusion Clinical FeaturesClinical Features
5Ps: Pain Pallor Parasthesia/Anesthesia Paralysis PulselessLimb is coldBleeding in trauma
![Page 20: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/20.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionDiagnostic StudiesDiagnostic Studies
Careful History taking and physical examination
History1.Trauma2.Atrial fibrillation, Mitral Stenosis3.H/O similar event4.Myocardial Infarction
![Page 21: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/21.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionDiagnostic StudiesDiagnostic Studies
Special Investigations1.Doppler ultrasound2.Duplex imaging3.Angiography/DSA4.X-Ray chest,ECG,Echo(Normalization of rhythm may
dislodge thrombus)5.Coagulogram6.MR Angiography7.Angioscopy.
![Page 22: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/22.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionDifferential DiagnosisDifferential Diagnosis
Difficult to differentiate Embolic from Thrombotic occlusion
1.DVT byEdemaParalysisfull veins
Phlegmesia alba dolens-Arterial flow -ntPhlegmesia cerulea dolens-Arterial flow +nt
![Page 23: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/23.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionDifferential DiagnosisDifferential Diagnosis
2.Aortic dissection3.Cardiac insufficiency4.Ergot intoxication5.Giant Cell Arteritis.
![Page 24: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/24.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement
Surgery within 12 hours1.Embolectomy2.Vascular repair3.Venous grafting4.Prosthetic graft5.Intraarterial thrombolysis
![Page 25: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/25.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement
Adverse effects of revascularisation:High feverMyoglobinuriaHyperkalemia >>> Cardiac arrestARF
Prevention is by Venotomy
![Page 26: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/26.jpg)
Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement
Medical TreatmentHeparinisationFibrinolytics- Streptokinase/UrokinaseTPA- Tissue Plasminogen Activator
![Page 27: Acute arterial occlussion](https://reader036.fdocuments.in/reader036/viewer/2022070600/58a484041a28ab58738b535b/html5/thumbnails/27.jpg)
Acute Arterial Occlusion Acute Arterial Occlusion
Complications:1.Gangrene 2.Secondary hemorrhage3.Volkmann’s Ischemic contracture4.A-V fistula5.False aneurysm6.Reperfusion complications