Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)


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Dec. 3rd, 2011

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Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)

  1. 1. Artery Emergencies
  2. 2. <ul><li>Acute Arterial Occlusion </li></ul><ul><li>Acute arterial occlusion is serious . It occurs when blood flow in a leg artery stops suddenly . If blood flow to the toe, foot, or leg is completely blocked, the tissue begins to die . This is called gangrene . If this happens, medical care is needed right away to restore blood flow and save the leg .  </li></ul>
  3. 4. <ul><li>go to the emergency room right away if you have any of the following : </li></ul><ul><li>Sudden pain in the leg or foot that may become severe </li></ul><ul><li>Pale or blue skin </li></ul><ul><li>Skin cold to the touch </li></ul><ul><li>Problems moving </li></ul><ul><li>No pulse where you used to be able to feel one </li></ul>
  4. 5. <ul><li>Causes of Acute Arterial Occlusion </li></ul><ul><li>This problem is more likely to occur in patients with peripheral arterial disease ( PAD ). With PAD, leg arteries are narrowed . This reduces blood flow to the legs and feet </li></ul>
  5. 6. <ul><li>How Is Acute Arterial Occlusion Diagnosed ? </li></ul><ul><li>Tests on blood flow are done . These tests may include : </li></ul><ul><li>Ankle - brachial index ( ABI ).   The blood pressure in the ankle is compared to the blood pressure in the arm . What is a normal and an abnormal ABPI? An ABPI of greater than 0.9 (90%) is considered to be normal.  An ABPI of beween 0.5 and 0.9 (50% to 90%) is consistent with symptoms of Intermittent Claudication . An ABPI of less than 0.5 (50%) is usually associated with more severe symptoms, even Critical Ischaemia . </li></ul><ul><li>Duplex ultrasound .   Painless sound waves are used to create images of blood flow in the legs . </li></ul><ul><li>Arteriography .   Contrast ( x - ray fluid ) is injected into the artery . This is done through a catheter ( thin, flexible tube ). The contrast makes blood vessels show up more clearly on x - rays . </li></ul>
  6. 7. <ul><li>How Is Acute Arterial Occlusion Treated ? </li></ul><ul><li>Possible treatments for acute arterial occlusion include : </li></ul><ul><li>Dissolving or removing a blood clot .   A catheter may be put into an artery in the groin to dissolve the clot . The catheter is then used to deliver “clot - busting” medication, which dissolves the clot . Or surgery may be done to remove the clot . An incision is made in the artery at the blocked section . The clot is then removed . </li></ul><ul><li>Angioplasty .   A small, uninflated balloon is passed through a catheter to the narrowed part of the artery . The balloon is then inflated to widen the artery . The balloon is then deflated and removed . </li></ul><ul><li>Stenting .   After angioplasty, a stent ( tiny wire mesh tube ) may be placed in the artery to help hold it open . The stent is also placed using a catheter . </li></ul><ul><li>Endarterectomy .   An incision is made in the artery at the blocked section . The material that blocks the artery is then removed from artery walls . </li></ul><ul><li>Peripheral bypass surgery .   A natural or man - made graft is used to bypass the blocked section of the artery . </li></ul>
  7. 8. Peripheral Vascular Injuries   <ul><li>Peripheral vascular injuries may result from penetrating or blunt trauma to the extremities . If not recognized and treated rapidly, injuries to major arteries, veins, and nerves may have disastrous consequences resulting in the loss of life and limb </li></ul>
  8. 9. <ul><li>Traumatic arterial injuries </li></ul><ul><li>Arteries can be occluded as a result of changes : </li></ul><ul><li>In the lumen (thrombosis). </li></ul><ul><li>In the wall (sub-intimal haematoma). </li></ul><ul><li>In the surrounding tissues (anterior tibial compartment). </li></ul>
  9. 10. Types of vascular injury <ul><li>* Contusion and thrombosis . </li></ul><ul><li>* Partial laceration of artery . </li></ul><ul><li>* Complete cut of artery . </li></ul><ul><li>* Arterio-venous fistula . </li></ul>
  10. 11. <ul><li>Types of vascular injury </li></ul><ul><li>Contusion </li></ul><ul><li>Puncture </li></ul><ul><li>Laceration </li></ul><ul><li>Transection </li></ul><ul><li>Clinical features </li></ul><ul><li>Depends on site, mechanism and extent of injury </li></ul><ul><li>Signs classically divided into 'hard' and 'soft' sign </li></ul>
  11. 12. <ul><li>Hard signs of vascular injury </li></ul><ul><li>Absent pulses </li></ul><ul><li>Bruit or palpable thrill </li></ul><ul><li>Active haemorrhage </li></ul><ul><li>Expanding haematoma </li></ul><ul><li>Distal ischaemia </li></ul><ul><li>Soft signs of vascular injury </li></ul><ul><li>Haematoma </li></ul><ul><li>History of haemorrhage at seen of accident </li></ul><ul><li>Unexplained hypotension </li></ul><ul><li>Peripheral nerve deficit </li></ul>
  12. 13. <ul><li>Difinite or Hot signs </li></ul><ul><li>Pulsatile or expanding haematoma </li></ul><ul><li>Pulsatile bleeding </li></ul><ul><li>Presence of thrill or bruit </li></ul><ul><li>End organ ischemia </li></ul>
  13. 14. Suggestive or Cold signs of arterial injury <ul><li>Unexplained shock </li></ul><ul><li>Stable haematoma </li></ul><ul><li>Injury to an adjacent nerve </li></ul><ul><li>Questionable history of arterial bleeding </li></ul><ul><li>proximity </li></ul>
  14. 15. When an artery exposed to trauma the injury could be in the form of <ul><li>Contusion and then thrombosis </li></ul><ul><li>Partial laceration of the wall of the artery </li></ul><ul><li>Complete transection(cut)of artery </li></ul><ul><li>A-V-F(communication bet. Artery and vein) </li></ul>
  15. 16. Abdominal Aortic Aneurysm (AAA) <ul><li>What is an aneurysm ? </li></ul><ul><li>An aneurysm is an area of a localized widening ( dilation ) of a blood vessel . ( The word &quot; aneurysm &quot; is borrowed from the Greek &quot; aneurysma &quot; meaning &quot; a widening). </li></ul>
  16. 17. <ul><li>Where do aortic aneurysms tend to develop ? </li></ul><ul><li>Aortic aneurysms can develop anywhere along the length of the aorta . The majority, however, are located along the abdominal aorta . Most ( about 90% ) of abdominal aneurysms are located below the level of the renal arteries, the vessels that leave the aorta to go to the kidneys . About two - thirds of abdominal aneurysms are not limited to just the aorta but extend from the aorta into one or both of the iliac arteries . </li></ul>
  17. 18. <ul><li>The most common symptoms of abdominal aortic aneurysm include general abdominal ( belly ) pain or discomfort, which may come and go or be constant . Other symptoms include : </li></ul><ul><li>Pain in the chest , abdomen , lower back, or flank ( over the kidneys ), possibly spreading to the groin, buttocks, or legs . The pain may be deep, aching, gnawing, and / or throbbing, and may last for hours or days . It is generally not affected by movement, although certain positions may be more comfortable than others . </li></ul><ul><li>A pulsating sensation in the abdomen . </li></ul><ul><li>A &quot; cold foot &quot; or a black or blue painful toe can happen if an abdominal aortic aneurysm produces a blood clot that breaks off and blocks blood flow to the legs or feet . </li></ul><ul><li>Fever or weight loss , if it is an inflammatory aortic aneurysm . </li></ul>
  18. 19. <ul><li>Surgery for Abdominal Aortic Aneurysm </li></ul><ul><li>During surgery for abdominal aortic aneurysm ( AAA ) , the weakened aortic wall is replaced with a hollow manmade tube ( a graft) </li></ul><ul><li>Risks and Complications </li></ul><ul><li>Infection </li></ul><ul><li>Blood clots in legs </li></ul><ul><li>Bleeding </li></ul><ul><li>Kidney failure </li></ul><ul><li>Pneumonia </li></ul><ul><li>Injury to the colon’s blood supply </li></ul><ul><li>Erectile dysfunction </li></ul><ul><li>Spinal cord injury </li></ul><ul><li>Heart attack, stroke, or death </li></ul><ul><li>Reaching the Aneurysm </li></ul><ul><li>The aorta can be reached through open surgery . Or a less invasive endovascular procedure may be done . </li></ul>