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Arterial disorders PPT.pptx.............
- 1. ARTERIAL DISORDERS DR. SHARAD BANSAL PGJR -1 GENERAL SURGERY
- 3. PERIPHERALARTERIAL OCCLUSION • Characterized by Pain (most common) pallor paralysis pulselessness paraesthesia
- 4. CAUSES • ATHEREOSCLEROSIS • BUERGER’S DISEASE • TAKAYASU ARTERITIS • SLE • POST TRAUMATIC • RADIATION INDUCED
- 5. ATHEROSCLEROSIS BUERGER’S DISEASE MOST COMMON AGE GROUP – 6-7th DECADE YOUNG MALE , SMOKER , AGE LESS THAN 40 YEARS INVOLVES LARGE AND MEDIUM SIZE VESSELS (ABDOMINAL AORTA , ILIAC, FEMORAL , POPLITEAL ) MAINLY SEEN IN LOWER LIMB SMALL AND MEDIUM SIZED VESSELS (TIBIAL , PLANTAR , RADIAL ) LOWER LIMB > UPPER LIMB
- 6. BUERGER’S DISEASE • AKA THROMOANGITIS OBLITERANS • INVOLVES SMALL AND MEDIUM SIZED VESSELS • T – TIBIAL • P – PLANTAR • R – RADIAL • EXTENDS FROM DISTAL TO PROXIMAL • INFLAMMATORY PROCESS INVOLVES – ARTERY , VEINS AND NERVES
- 7. CLINICAL FEATURES • TRIAD • R – RAYNAUD’S PHENOMENON • I- INTERMITTENT CLAUDICATION • M- MIGRATORY SUPERFICIAL THROMOBOPHLEBITIS
- 9. DIAGNOSIS- • IOC- FOUR LIMB ANGIOGRAPHY • THERE IS CHARACTERISTICS COLLATERLS PRESENT KNOWN AS CORKSCREW COLLATERLS . • ABPI- ANKLE BRACHIAL PRESSURE INDEX • ABPI- SYSTOLIC BP ANKLEARM
- 11. ABPI- 0.1-0.4 CRITICAL LIMB ISCHEMIA 0.5-O.9 INTERMITTENT CLAUDICATION 1-1.2 NORMAL >1.2 CLAUDICATION
- 12. FONATINE’S STAGING FOR LIMB ISCHEMIA
- 13. NOTE- • PATIENTS HANGS THEIR LEGS WHILE SLEEPING AND SITTING AS IT RELIEVE PAIN.
- 14. TREATMENT • ABSTINENCE FROM SMOKING. • VASODILATORS –XANTHINOL NICOTINATE PENTOXYPHYLINE. • LUMBAR SYMPATHECTOMY- IS DONE ONLY FOR REST PAIN (DUE TO CUTANEOUS ISCHEMIA ) . BECAUSE BLOOD SUPPLY OF MUSCLES IS NOT UNDER CONTROL OF SYMPATHETIC SYSTEM. • FOR GANGRENE – AMPUTATION.
- 15. ATHEREOSCLEROSIS • OCCURS IN >5TH DECADE • MALES=FEMALES • LOWER LIMB > UPPER LIMB • INVOLVES ARTERY • INVOLVES LARGE TO MEDIUM SIZED VESSELS • SPREAD – PROXIMAL TO DISTAL SPREAD
- 16. MANAGEMENT OF ATHEREOSCLEROSIS- • BYPASS GRAFTING AND SHUNTING • ANGIOPLASTY
- 17. ARTERIAL ULCERS • LOCATION – LATERAL SURFACE OF ANKLE / DISTAL DIGITS • PUNCHED OUT ULCER • INTENSLY PAINFUL • DISTAL PULSES NOT PALPABLE • THIN SHINY SKIN • LACK OF HAIR • BRITTLE NAILS
- 18. • MICROANGIOPATHY > ENDOTHELIAL DYSFUNCTION > ISCHEMIA > PUNCHED OUT ULCER • DIAGNOSIS IS MADE CLINICALLY • DOPPLER IS PERFORMED TO ASSESS THE BLOOD FLOW. • TREATMENT – REVASCULARIZATION PROCEDURE DONE FOR INFECTED ULCERS- ANTIBIOTICS + DEBRIDEMENT DONE.
- 19. RAYNAUD’S PHENOMENON - • ITS AN EPISODIC DIGITAL ISCHEMIA ON EXPOSURE OF COLD , EMOTIONAL STRESS, USE OF VIBRATING TOOLS. • MANIFESTED BY SEQUENTIAL DEVELOPMENT OF DIGITAL BLANCHING , CYANOSIS , REDNESS IN FINGERS AND TOES • MOST COMMON IN FINGERS > TOES
- 20. BLANCHING > CYANOSIS > REDNESS ( BCR )
- 21. TREATMENT • >90 % PATIENTS IMPROVES ON AVOIDING STIMULUS . • IF NO IMPROVEMENT , TO RELIEVE SPASMS- • CALCIUM CHANNEL BLOCKERS – DILTIAZEM , NIFEDIPINE.