This topic is under the category of Arterial Diseases. One of the subtopic is CLI. One of the ommon causes for CLI, is Atherosclerosis, which is discussed in this PPT.

1. Prof. U. Murali.
Chronic
Arterial Diseases

2. Learning Objectives
◼ Outline the surgical anatomy of UL & LL.
◼ Classify arterial diseases & C L I.
◼ List the features of arterial stenosis / ischemia.
◼ Enumerate the causes of chronic limb ischemia.
◼ Mention the risk factors & complications of atherosclerosis.
◼ Explain the pathogenesis & management of atherosclerosis.

6. A D - Include
Major arterial (occlusive) Diseases
Peripheral arterial (occlusive) Diseases
Aorta / Carotids / Iliac arteries
Limb & Distal vessels – LL / UL

7. Arterial Diseases – Types
ACUTE [ALI]
◼ Trauma / Injury
◼ Spasm – Intra-arterial inj.
◼ Embolism / Thrombosis
CHRONIC [CLI]
◼ Atherosclerosis
◼ TAO
◼ Raynaud’s Disease
◼ Arteritis / Vasculitis
◼ Radiation

8. Chronic Limb Ischemia - Classification

9. Chronic Limb Ischemia - Classification

10. C. Limb Ischemia - Causes
◼ Atherosclerosis
◼ Arteriopathies – TAO /
Raynaud’s & Takayasu’s D.
◼ Diabetes
◼ Scleroderma
◼ Physical agents – trauma /
tourniquet / radiation injury

11. 11
Features of Chronic Arterial Diseases
Stenosis Ischemia
• Intermittent claudication
• Rest pain
• Cold periphery / numbness /
paraesthesia / colour changes
• Ulceration, gangrene
• Altered sensation / movements
• Diminished / absent arterial
pulsation
• Thrill / bruit over the stenosed artery
• Altered capillary filling — normally
it is in few seconds; it is delayed in
arterial stenosis
• Marked pallor / Cyanosed app
• Thinning of skin
• Diminished hair
• Loss of subcutaneous fat
• Brittle nails - Transverse
ridges
• Ulceration in digits
• Wasting of muscles
• Tenderness and Temp -
cold

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25. Treatment Plan – A D – Medical
General Measures Drugs
• Stop Smoking
• Lifestyle changes
• Care of feet
• Control – DM / HT
• Buerger’s position /
exercise
• Anti-lipid - Statins
• Anti-platelet – LDA / C.GREL
• Vasodilators – PP / DP
• Cilostazol – ↓ platelet agg.
• Analgesics / Sedatives
• Prostaglandins

26. PAD - Treatment
Surgery
• PTA – Localised areas
• Endarterectomy / Atherectomy
• Thrombectomy
• Profundaplasty
• Bypass graft surgeries
• Sympathectomy
• Amputations – if gangrenous

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33. Atherosclerosis
Prof. U.Murali.

34. Atherosclerosis - Definition
◼ It is a chronic, complex
inflammatory condition of
elastic and muscular arteries,
involving as systemic and
segmental.
◼ It begins in childhood as fatty
streaks.
◼ Lipid plaque forms inside the
arterial wall, cause narrowing
& hardening of artery.

35. Atherosclerosis – Risk factors
DEFINITIVE
◼ Hypercholesterolemia
◼ Smoking
◼ Hypertension
◼ Diabetes
RELATIVE
◼ Age – Elderly
◼ Sedentary life – Obesity
◼ Family history
◼ Commonly – Males

36. Arteries involved
COMMON
◼ Abd aorta – Infra-renal part
◼ Coronary
◼ Ilio-femoral
◼ Bifurcation of carotid
◼ Popliteal
LESS COMMON
◼ Upper limb
◼ Common carotid
◼ Mesenteric arteries
◼ Renal arteries

37. Atherosclerosis - Pathogenesis

38. Atherosclerosis - Complications

39. Atherosclerosis - Management

40. To Summarize
◼ Arteries of UL & LL.
◼ Types of arterial diseases & Classification of CLI.
◼ Causes & Features of arterial stenosis / ischemia.
◼ Intermittent claudication – Types & Rest pain.
◼ Investigations & Treatment aspects of C L I.
◼ Risk factors, pathogenesis & management of atherosclerosis.

41. References

42. Question Time
◼ List 5 features of chronic arterial diseases.
◼ Classify chronic limb ischaemia.
◼ Enumerate the definitive & relative risk factors of atherosclerosis.
◼ Differentiate between intermittent claudication & rest pain.
◼ Write any 4 differences between arterial, venous & neurogenic claudication.
◼ Expand ABPI. Add a note on it.
◼ Outline the pathogenesis & complications of atherosclerosis.
◼ Mention the surgical methods in treating C L I.

43. Features of critical limb ischemia do not
include –
◼ a) Gangrene.
◼ b) Claudication distance of < 50 yards.
◼ c) Ulceration.
◼ d) Toe pressure of < 30 mm Hg.

44. A 45-year-old truck driver is seen in clinic C/O bilateral buttock and thigh claudication at 50
meters. He confides that he has recently become impotent. He is a smoker and has a medical
history of hypertension, for which he takes treatment. O/E, he has weak femoral and absent
popliteal and pedal pulses. His feet are pale and cold. Duplex confirms your diagnosis. The
most appropriate intervention would be –
◼ a) Femorol-popliteal bypass.
◼ b) Bilateral femoral angioplasty.
◼ c) Femoral-crural bypass.
◼ d) Aorto-bifemoral bypass.

45. Intermittent claudication at the level of the
hip indicates -
◼ a) Popliteal artery occlusion.
◼ b) Bilateral iliac artery occlusion.
◼ c) Common femoral occlusion.
◼ d) Superficial femoral artery occlusion.

46. What will be the diagnosis of Mr. X, who is 45-years old
male with history of chronic smoking and pain in lower
limb due to blockage of femoral artery? –
◼ a) Thromboangitis obliterans.
◼ b) Embolism.
◼ c) Arteritis.
◼ d) Atherosclerosis.

47. One of the following is a feature of lower
limb arterial stenosis or occlusion -
◼ a) Wasting of muscles.
◼ b) Rest pain.
◼ c) Loss of sensation.
◼ d) Rapid capillary filling.

48. Your senior colleague asks you to see a patient in clinic who has
Fontaine’s classification [FC] stage 3 peripheral vascular disease
[PVD]. Which one of the following options best describes the
symptoms associated with stage 3 of FC of PVD? –
◼ a) Intermittent claudication.
◼ b) Ischemic rest pain.
◼ c) Asymptomatic.
◼ d) Ulceration.

51. Palpation of Lower Limb Vessels

52. Palpation of Upper Limb Vessels

56. THANK YOU