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Arterial dse MB6.pptx
- 1. ARTERIAL VASO-OCCLUSIVE DISEASE Dr WinstonMakanga, M.B.Ch.B, M.Med (Surg) Consultant General and Laparoscopic Surgeon MBChB 6 Thursday, November 17, 2022
- 2. Objectives of thelecture • Surgical anatomy • Physiology and functions • Epidemiology • Etiology • Work-up (screening, diagnosis, staging) • Treatment
- 3. Scope of diseases •Trauma and its sequelae (blunt vs trauma) • Pseudoaneurysm • Intimal flap • Laceration (partial vs complete) • Aneurysmal disease • Aorta • Popliteal • Occlusive disease (coronary, mesenteric, peripheral, cerebral) • Atherosclerosis • Raynaud’s disease • Buergers disease • HIV vasculopathy • Embolism
- 4. Arterial trauma • Laceration •Transection • Contusion • Pseudoaneurysm • Extrinsic compression • AV fistula
- 5.
- 6. Pathology of vaso-occlusivedisease • Acute ischemia: thrombotic or embolic • Sudden formation of hemostatic plug over a pre-existing ruptured atheroma • Chronic ischemia: atherosclerosis • Progressive deposition of lipids in the intima with reactive inflammation • Macrovascular disease: affects large named vessels • Microvascular disease: affects small <0.3 mm vessels
- 7. Etiology • Smoking • Diabetesmellitus • Hypertension • HIV • Connective tissue disease • Age • Obesity and sedentary lifestyle • Dyslipidemia
- 8. Acute Presentation • Pain •Parasthesia • Pulslessness • Paralysis • Coldness
- 9. Fontaine Classification ofchronic disease I. Assymptomatic II. Intermittent claudication III. Rest pain IV. Tissue damage (ulcer/gangrene)
- 10. Classification by lengthinvolved • Class A <3cm • Class B 3 – 15 cm • Class C > 15 cm • Class D Complete occlusion
- 11. Clinical evaluation • History •Duration of pain/claudication distance • Prior Rx for cardiac(angina)/aortic, cerebrovascular dx (TIA, CVA), amputation • Coexistance of connective tissue disease – SLE • Risk factor assessment: smoking, DM, HIV, dyslipidemia, ergot poisoning • Examination • CVS: pulse rate, rhythm, murmurs, abdominal pulsations and bruits • Limb: skin, temperature, ABPI, pulses, cap refill, venous guttering, bruits • Buergers test, exercise test
- 12. Investigation • General bloodtests • RBS, HbA1c, urine sugar, UEC, Lipid levels, HIV test, CRP, ASA, Rh • Cardiac assessment • CXR, ECG, echo • Specific limb/vascular exam • Doppler (with quantitative ABPI) • Duplex scan • Angiography (conventional, DSA, CT or MR Angiography)
- 14. Differential diagnosis • Venousclaudication • Neurogenic claudication • Chronic compartment syndrome • Bakers cyst • Cord compression • Arthritis
- 15. Treatment options • Generalreduction of cardiovascular risk: • Cessation of smoking, lipid lowering, control DM & HTN, antiplatelet meds • Angioplasty • Balloon dilatation • Endovascular stenting • Endaterectomy • Grafting • Acute obstruction • Thrombolysis • Thrombectomy • Embolectomy • Class 4: Amputations, debridement
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