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010 Arteries - Introduction to Clinical Surgery Lectures
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010 Arteries - Introduction to Clinical Surgery Lectures

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Lecture on arteries from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

Lecture on arteries from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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010 Arteries - Introduction to Clinical Surgery Lectures Presentation Transcript

  • 1. The Arteries Nick Harvey
  • 2. Limb Ischaemia: Definitions
    • Acute
      • Sudden interruption if blood supply
      • Caused by emboli, trauma
      • No collaterals
    • Chronic
      • Gradual obstruction of blood supply
      • Caused by atherosclerosis
      • Collaterals often well developed
    • Acute on Chronic
      • Acute thrombosis
  • 3. Limb Ischaemia: Symptoms of Chronic Ischaemia
    • Claudication
    • Rest Pain
    • Impotence
    • Commonly associated with:
      • CVS – hypertension, angina, MI
      • Cerebrovascular – strokes, TIAs
    • Risk factors:
      • smoking, hyperlipidaemia, DM, sedentary life
  • 4. Limb Ischaemia: Presentation of Acute Ischaemia
    • Pain
    • Pallor
    • Perishingly cold
    • Pulseless
    • Paresthesia
    • Paralysis
  • 5. Limb Ischaemia: History
    • Claudication Pain
      • Cramping muscle pain that is caused by exercise and relieved by rest
      • Due to muscle ischaemia
        • Claudication distance: increasing, decreasing or static?
        • Does it affect patient’s lifestyle?
  • 6. Limb Ischaemia: History
    • Rest Pain
      • Continuous pain present at rest
      • Toes or forefoot
      • Increased by exercise and warmth
      • Relieved by hanging legs over the side of the bed
      • Rest pain is due to nerve ischaemia
        • Diabetic neuropathy sufferers?
  • 7. Limb Ischaemia: Aorto-iliac Occlusive Disease
    • Bilateral Claudication
    • Impotence
    • Bilateral decreased or absent pulsations
  • 8. Limb Ischaemia: Femoro-popliteal Occlusive Disease
    • Unilateral Calf Claudication
    • Absent Pulses Below Femoral Artery
  • 9. Limb Ischaemia: Tibio-peroneal Occlusive Disease
    • Unilateral Foot Claudication
    • Absent Pulses Below Popliteal
    • Rest pain, ulcers or gangrene
  • 10. Limb Ischaemia: General Examination
    • Pulse, BP both arms
    • Pallor
    • Heart
    • Scars of previous arterial surgery
  • 11. Limb Ischaemia: Local Examination Inspection
    • Skin
    • Nails
    • Trophic changes
      • Hair loss, thin skin, muscle wasting
    • Ulcers
      • check pressure areas including between digits
    • Gangrene
  • 12. Limb Ischaemia: Local Examination Inspection
    • Colour
      • Horizontal
      • Elevated
        • determine vascular (Buerger’s) angle
      • Depended
  • 13. Limb Ischaemia: Local Examination Palpation & Auscultation
    • Palpate
    • Skin temperature
    • CRT
    • Pulses
      • DP, PT, popliteal, femoral, aorta, carotids, brachial, radial
    • Auscultation
      • All major arteries