The document discusses atherosclerosis, aneurysms, carotid body tumors, and varicose veins. It defines each condition and describes their causes, risk factors, clinical features, investigations, and treatments. Atherosclerosis involves plaque buildup in arteries leading to narrowing or blockage and tissue ischemia. Treatments include risk factor modification, medications, angioplasty, surgeries like endarterectomy, and bypass grafts. Aneurysms are abnormal artery dilations over 50% in size caused mainly by atherosclerosis, with repair via open or endovascular grafting. Carotid body tumors are rare, usually benign growths at the carotid bifurcation treated by surgical excision. Varicose veins result

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Atherosclerosis
 Atherosclerosis is a disease of large and medium sized
muscular arteries with sub-intimal deposition of
atherosclerotic plaque consisting of lipids, smooth muscle cells,
macrophages, cholesterol, calcium and cellular debris resulting in
arterial stenosis or block
 This results in tissue ischaemia or infarction distally

3. Atherosclerosis
 Atherosclerotic plaques are more at the regions of
branching of arteries
 Stenosis more than 40% is critical, may cause atrophy of
tunica media leading to dilatation(aneurysm)
 Common arteries involved are
 Coronary arteries
 Infrarenal abdominal aorta
 Iliofemoral arteries
 Carotid bifurcation
 Popliteal arteries
 Mesenteric arteries

4. Atherosclerosis

5. Atherosclerosis
 Abdominal aorta
 Carotid bifurcation

6. Atherosclerosis-Risk factors
Definitive
• Hypercholesterolaemia and
hyperlipidaemia
• Cholesterol > 200mg%
• High LDL > 100mg%
• Low HDL < 35mg%
• Smoking
• Hypertension
• Diabetes mellitus
Relative
• Age-elderly
• Males
• Hypertriglyceridaemia
• Sedentary life, obesity
• Family history

7. Atherosclerosis-clinical features
 Common after 50 years of age
 Males>Females, Positive family history for
atherosclerosis
 Smoking, hypertension, diabetes and raised cholesterol
levels
 Arterial wall thickening
 Thrill or bruit over carotid, femoral, renal arteries
 Features of ischaemia in the limb
 Claudication
 Ulceration or gangrene of parts of limb
 Feeble or absent pulsations
 Transient ischaemic attacks, chest pain, sudden black out,
post prandial abdominal pain or altered renal function

8. Atherosclerosis-Investigations
 Blood sugar
 Fasting lipid profile
 ECG
 Echocardiogram
 Tread mill test
 Ultrasound abdomen
 Duplex scanning of suspected arteries
 Angiogram showing site, extent & percentage of block and
collaterals
 DSA
 CT angiogram
 MR angiogram

9. Atherosclerosis-Management
 Risk factor modification
 Drugs
 Aspirin, clopidogrel, atorvostatin, cilastazol, pentoxyphylline
 Percutaneous transluminal angioplasty(PTA)
 Surgeries
 Thrombectomy, endarterectomy, profundaplasty
 Arterial by pass using reverse saphenous vein graft
 By pass grafts:
 CABG(Coronary Artery Bypass Graft)
 Aortofemoral,
 Iliofemoral,
 Femoropopliteal etc
 Amputations if limb is gangrenous

10. Atherosclerosis
 Percutaneous transluminal angioplasty

11. Atherosclerosis
 Percutaneous transluminal angioplasty

12. Atherosclerosis
 Percutaneous transluminal angioplasty and atherectomy

13. Atherosclerosis
 Bypass grafts
Coronary Artery Bypass Graft(CABG) Aortoiliac bypass

15. Aneurysm
 Abnormal permanent dilatation of localised segment of
artery
 Diameter is more than 50% of normal
 Atherosclerosis is most common cause(90%)
 Types
 True : contains all three layers of artery
 False : contains single layer of fibrous tissue as a wall

16. Aneurysm-types
1. Fusiform
2. Saccular
3. Dissecting

17. Aneurysm-Aetiology
Acquired
 Degenerative: Atherosclerosis
 Traumatic
 Infective
 Mycotic
 Syphilitic
 Collagen diseases like Marfan’s syndrome, Polyarteritis
nodosa etc.
Congenital
 Berry aneurysm occurring in arteries of circle of Willis

18. Aneurysm
Sites of aneurysm
 Aorta
 Femoral
 Popliteal
 Subclavian
 Cerebral, renal, mesenteric, splenic arteries

19. Aneurysm
Complications of aneurysm
 Thrombosis and distal ischaemia
 Embolism and acute arterial occlusion
 Pressure effects
 On bone(erosion)
 Skin
 Veins (oedema)
 Nerves( pain, paraesthesia)
 Stomach(erosion leading to haematemesis)
 Oesophagus (dysphagia)
 Rupture and haemorrhage
 Infection of aneurysm

20. Aneurysm-clinical features
 Pulsatile swelling
 Thrill & bruit
 Distal oedema due to venous compression
 Altered sensation due to compression of nerves
 Erosion into bones, joints, trachea or oesophagus
 Embolism resulting in gangrene of toes, digits
Investigations
 Duplex scanning
 Angiogram( CT, MRI, DSA)
 Blood sugar, lipid profile, echocardiography

21. Aneurysm-Treatment
 Reconstruction of artery using arterial graft
 Arterial endoaneurysmorrhaphy
 Therapeutic embolisation
 Clipping of aneurysm
 Endovascular graft

22. Aneurysm
Open & Endovascular repair

24. Carotid body tumour
 Also known as Potato tumour, Chemodectoma, Non
chromaffin paraganglioma
 Arises from carotid body located at the bifurcation of
common carotid artery

25. Carotid body tumour
 Usually benign or locally
malignant. Occasionally
lymphatic spread occurs
 Well encapsulated, hard
creamy yellowish tumour
 Not hormonally active
Clinical features
 Usually unilateral in middle
age
 Firm pulsatile swelling(75%)
in the region of carotid
bifurcation
 Head ache, neck pain,
syncope, dysphagia

26. Carotid body tumour
Investigations
 Duplex scanning
 Carotid angiogram
 CT scan, MRI, MR
angiography

27. Carotid body tumour-Treatment
 Excision followed by vascular graft if necessary

29. Varicose veins
 Dilated, tortuous , elongated veins in the leg of long or short
saphenous system
 Caused by incompetence of valves of main segment or
perforators

30. Varicose veins

31. Varicose veins
Aetiology
 Primary
 Congenital weakness of wall of veins or absence of valves
 Prolonged standing
 Congenital AV malformation
 Secondary
 Pregnancy
 Pelvic tumours
 Traumatic arteriovenous fistula

32. Varicose veins-clinical features
 Dull ache in calf in the
evening
 Bleeding
 Eczema
 Pigmentation
 Varicose ulcer

33. Varicose veins
Signs
 Brodie-Trendelenburg test for SFJ and perforator incompetence
 Triple tourniquet test
 Perthe’ test for patency of deep veins
Complications
 Haemorrhage
 Pigmentation, eczema and ulcer
 Periosteitis
 Equinus deformity
 Thrombophlebitis

34. Varicose veins
Investigations
 Duplex scanning of leg veins
Treatment
 Elastic stockings
 Injection sclerotherapy for
below knee varicosities
 Juxtafemoral ligation of great
saphenous
vein(Trendelenburg’s
operation)
 Stripping of veins
 Subfascial perforator ligation
 Endovenous laser ablation

35. Varicose veins
Endovascular laser treatment

36. Thank you