PATHOLOGY OF VASCULAR OCCLUSION, ATHEROSCLEROSIS, HYPERTENSION AND LYMPHEDEMA
Basic principles of vascular surgery Anatomy Physiology Pathology Pathophysiology Clinical...
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Transcript of Basic principles of vascular surgery Anatomy Physiology Pathology Pathophysiology Clinical...
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