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‫خدا‬ ‫نام‬ ‫به‬
 Anatomy of Artery
 Peripheral Arterial Disease
 Acute Arterial Occlusion
 PAD(Peripheral Arterial Disease):Peripheral
arterial disease (PAD) is characterized by
occlusions or stenoses (partial occlusions) of
the arteries
 of the lower extremities. Specific symptoms are
dictated by the number and severity of
occlusions, the degree
 of collateralization, and the patient’s tolerance
to limitations in walking distance.
 Femoropopliteal Occlusive disease=>. Disease
confined below the inguinal ligament is known as
femoropopliteal
 occlusive disease The most common site of disease is
the distal superficial femoral artery (SFA) within the
 adductor (Hunter’s) canal.
 Tibial Occlusive disease=>
 Involvement of the arteries below the popliteal
trifurcation
 is called “tibial occlusive disease.” Tibial occlusive
disease is common in patients with diabetes, end-
stage renal
 failure, and advanced age.
 Etiology of PAD:
 Atherosclerosis
 Buerger disease(thromboarteritis obliterans)
 Cystic adventitial disease
 Compression of arteries(Popliteal artery entrapment
and cervical rib)
 Symptoms:
 Intemittent claudication
 Ischemic rest pain
 Skin ulceration
 gangrene
 Leriche syndrome
 SFA
ARTERIAL ULCER
 Dry gangrene wet gangrene
 Evaluation:
 Physical Exam:
 1-Femoral artery
 2-popliteal artery
 3-Dorsalis pedis artery
 4-posterior tibial artery
 Diagnosis:
 Indication CTA or MRA:
 1- severe life style- limiting claudication
 2-gangrene
 3-rest pain
 Angiography
 Treatment:
 Medical management
 Endovascular therapy
 PTA
 Stent
 Atherectomy
 Surgical management
 Surgical management:
 Endarterectomy
 Aortobifemoral bypass
 Extra anatomic bypass
 profundoplasty&femoral endarterectomy
 Femoropopliteal bypass
 Amputation
Figure 26-16 Atherectomy refers to the
mechanical removal of plaque by debulking
it, as opposed to
compressing it against the arterial wall,
which occurs with balloon angioplasty.
 Acute Arterial Occlusion
 in situ thrombosis of preexisting atherosclerotic
occlusive disease,
 arterial emboli from another site,
 penetrating and blunt trauma, and
 thrombosis of a preexisting arterial aneurysm
 Acute Artrial Occlusive in limb:
 6p
 Pallor
 Pain
 Paresthesia
 Paralysis
 Pulselessness
 Poikilothermia(change in temperature)
 Treatment:
 Embolectomy
 Bypass
 Endarterectomy
 Thrombolytic therapy
 Systemic ischemia –reperfusion syndrome:
 Compartment syndrome
 Hyperkalemia
 Metabolic acidosis
 Myoglobinuria
 Renal and pulmonary insufficiency

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Artery&disease

  • 1. ‫خدا‬ ‫نام‬ ‫به‬  Anatomy of Artery  Peripheral Arterial Disease  Acute Arterial Occlusion
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.  PAD(Peripheral Arterial Disease):Peripheral arterial disease (PAD) is characterized by occlusions or stenoses (partial occlusions) of the arteries  of the lower extremities. Specific symptoms are dictated by the number and severity of occlusions, the degree  of collateralization, and the patient’s tolerance to limitations in walking distance.
  • 8.  Femoropopliteal Occlusive disease=>. Disease confined below the inguinal ligament is known as femoropopliteal  occlusive disease The most common site of disease is the distal superficial femoral artery (SFA) within the  adductor (Hunter’s) canal.
  • 9.  Tibial Occlusive disease=>  Involvement of the arteries below the popliteal trifurcation  is called “tibial occlusive disease.” Tibial occlusive disease is common in patients with diabetes, end- stage renal  failure, and advanced age.
  • 10.  Etiology of PAD:  Atherosclerosis  Buerger disease(thromboarteritis obliterans)  Cystic adventitial disease  Compression of arteries(Popliteal artery entrapment and cervical rib)
  • 11.  Symptoms:  Intemittent claudication  Ischemic rest pain  Skin ulceration  gangrene  Leriche syndrome  SFA
  • 13.  Dry gangrene wet gangrene
  • 14.  Evaluation:  Physical Exam:  1-Femoral artery  2-popliteal artery  3-Dorsalis pedis artery  4-posterior tibial artery
  • 15.
  • 16.
  • 17.  Diagnosis:  Indication CTA or MRA:  1- severe life style- limiting claudication  2-gangrene  3-rest pain  Angiography
  • 18.  Treatment:  Medical management  Endovascular therapy  PTA  Stent  Atherectomy  Surgical management
  • 19.  Surgical management:  Endarterectomy  Aortobifemoral bypass  Extra anatomic bypass  profundoplasty&femoral endarterectomy  Femoropopliteal bypass  Amputation
  • 20.
  • 21.
  • 22. Figure 26-16 Atherectomy refers to the mechanical removal of plaque by debulking it, as opposed to compressing it against the arterial wall, which occurs with balloon angioplasty.
  • 23.  Acute Arterial Occlusion  in situ thrombosis of preexisting atherosclerotic occlusive disease,  arterial emboli from another site,  penetrating and blunt trauma, and  thrombosis of a preexisting arterial aneurysm
  • 24.  Acute Artrial Occlusive in limb:  6p  Pallor  Pain  Paresthesia  Paralysis  Pulselessness  Poikilothermia(change in temperature)
  • 25.  Treatment:  Embolectomy  Bypass  Endarterectomy  Thrombolytic therapy
  • 26.  Systemic ischemia –reperfusion syndrome:  Compartment syndrome  Hyperkalemia  Metabolic acidosis  Myoglobinuria  Renal and pulmonary insufficiency