Patient with a toe gangrene coming to Emergency Department
Joel Arudchelvam
Atherosclerotic OAD – Risk factors
Presentation
FONTAINE CLASSIFICATION
Rutherford classification
SVS Lower Extremity Threatened Limb (WIFI) classification
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
Surgical Management of Lower Limb Occlusive Arterial Diseaserajendra meena
This slide explains briefly touches upon Occlusive Arterial Disease (Peripheral Arterial Disease (PAD)) in the lower limbs along with the types, classification, diagnostic evaluation and various management protocols.
Connections Between Hepatic and Cardiovascular Disease,Diagnostic criteria for cirrhotic cardiomyopathy 2005 and 2019.New CCM criteria based
on contemporary CV imaging parameters
LV Systolic Function.
LV Diastolic Dysfunction.cardiac evaluation algorithm for liver transplant candidates
Surgical management of typhoid enteric perforationKETAN VAGHOLKAR
there are various surgical options to treat enteric perforations in typhoid. the optimal choice of the method plays a significant role in the outcome of the treatment.
Surgical Management of Lower Limb Occlusive Arterial Diseaserajendra meena
This slide explains briefly touches upon Occlusive Arterial Disease (Peripheral Arterial Disease (PAD)) in the lower limbs along with the types, classification, diagnostic evaluation and various management protocols.
Connections Between Hepatic and Cardiovascular Disease,Diagnostic criteria for cirrhotic cardiomyopathy 2005 and 2019.New CCM criteria based
on contemporary CV imaging parameters
LV Systolic Function.
LV Diastolic Dysfunction.cardiac evaluation algorithm for liver transplant candidates
Surgical management of typhoid enteric perforationKETAN VAGHOLKAR
there are various surgical options to treat enteric perforations in typhoid. the optimal choice of the method plays a significant role in the outcome of the treatment.
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e va...ASMaD
Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
PAD can be diagnosed in asymptomatic individuals by a combination of physical examination and simple, noninvasive Doppler ultrasonography to measure the ankle–brachial index
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
Principles of management of Neck vascular trauma
Pre Congress Workshop on
Vascular Trauma
September 2023
Joel Arudchelvam
Causes
Impalement
Signs of neck vascular injuries
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Changing concepts
Ligation Vs Repair
Neurological status and carotid repair
Diabetic foot and Foot care
Dr Joel Arudchelvam
Definition
Prevalence
Teaching Hospital Anuradhapura [THA]
High risk foot
Neuropathy
Pathogenesis of neuropathy
Charcot foot
Testing for neuropathy
Local Ulcer care
Managing Venous Ulcers Pre-congress Workshop
Wound Care in the Elderly
Scientific Conference of the Sri Lankan Association of Geriatric Medicine
Dr Joel Arudchelvam
Chronic Venous Diseases
CEAP Classification
Chronic Venous Ulcer
Pathophysiology
Investigations
Venous Duplex Scan
Treatment
LASER - Light Amplification by Stimulated Emission of Radiation
Sclerotherapy
Multi layer compression dressing (strapping)
Compliance
Cost and problems
Methods of leg elevation
Annual Academic Conference
SLSVS 23
Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon
Aortic aneurysms
Abnormal focal dilatation of a vessel of more than 50 % of its normal diameter
Abdominal aorta more than 3 cms (normal diameter - 2 cms)
Open AAA repair
Endo Vascular Aneurysm Repair (EVAR)
Arch de-branching
Sri Lankan Experience
15 Vascular and transplant units
Emergency AAA repair
Open TAA repair
Future directions
ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications
Carotid artery injuries, Joel Arudchelvam, SLSC 2022, Carotid artery injuries
Causes
Hard signs of vascular injury
Associated signs
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Management – changing concepts
Vascular surgical intervention
Open surgery
Certificate in Teaching in Higher Education (CTHE) 2022
Post ward round discussion in medical student teaching results in better understanding
Joel Arudchelvam
Advantages of ward round teaching
Problems related to the wards
The responses from the students
Future plans
Joel Arudchelvam
Definition
Donor types
HISTORY OF TRASNPLANTATION in Sri Lanka
Transplantation procedure
Organ preservation
BASIC COMPONENTS OF PRESERVATION SOLUTIONS
135TH ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS 2022
30th September 2022
At BMICH, Colombo.
Symposium on
Solid Organ transplantation
Kidney transplantation - Challenges and
Experiences
Kidney transplantation
Causes for chronic kidney dise
Chronic Kidney Disease of unkn
Paediatric kidney transplant
Teaching Hospital Anuradhapura
The university transplant unit
Live donor nephrectomy
Organ preservation
Iliac vessel mobilisation
Renal vessels ananstomosis
Ureter anastomois
Surgical aspects
user experience
Relationship of live donors (T
Area of residence of donors
Live Donor profile
Donor vascular variations
Vascular reconstruction
Jaffna Medical association
Annual Scientific Sessions September, 2022
Professor C.Sivagnanasundaram memorial oration
Introduction
Vascular injuries are potentially life or limb threatening. Vascular trauma occurs in 1.6% of civilian injuries (1) and 6.8% to 10.8% in war related injuries (Afghanistan, Iraq and Lebanon war). In a study done at the National hospital of Sri Lanka Colombo (NHSL) out of 5802 trauma admissions there were 93 patients with vascular injuries (VI). Therefore the incidence of VI in civilian trauma is 1.6% (1). After the end of civil war in Sri Lanka in 2009 there is a reduction in the number of war related vascular injuries. But due to the increase in the number of Road Traffic Accidents (RTA), the number of vascular trauma also increased (i.e. from 1938 to 2013 road traffic injuries increased from 35.1 to 98.6 per 100 000 population in Sri Lanka). One of the reasons for this is the increased number two and three wheeled vehicles which are involved more with accidents (2). Trauma and vascular injuries often involve young males. They are the breadwinners of the family. In one study done at the Teaching Hospital Anuradhapura (THA) among patients presenting with popliteal arterial injuries, 18 (90%) were males with a mean age of 38.7 years (2). And in another study done at the same institution among patients with major lower limb arterial injuries, 22 (87.5%) were males and the mean age was 36.9 years (3). These studies confirm the fact of young males often getting involved with vascular injuries.
Vascular injuries occur
• Unexpected
• Young and fit
• Results in loss of limb or life
• Loss of earning capacity, economic
Our experience at Anuradhapura
Mean age - 36.9 years (17–69)
Arterial injury following trap gun - 25% amputation rate (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8
Causes - Road Traffic Accidents – 54.2%,Trap Gun – 33.3%,Iatrogenic - 8.33%,Other- 4.2% (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8)
Mechanism of injury
• Sharp / penetrating
• Blunt
“Vascular injury” is a nonspecific term. Because this is used to describe the injuries
to blood vessels in all parts of the body that includes neck vascular injuries, thoracic and
abdominal vascular injuries, and injuries to the blood vessels of the limbs. And in addition
vascular injury also describes injuries to the arteries and veins. Injuries to the blood vessels of
the limbs are called extremity vascular injury. This chapter will concentrate on the extremity
vascular injuries.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. 65 year old male
Blackish discoloration of the toes for 3 days
Pain
Ulcer with purulent discharge on plantar surface
at the base of toes
Smoker
Hypertension , diabetes mellitus
9. Stage Symptoms
I Asymptomatic
II Intermittent claudication
IIa Pain-free, claudication walking >200 m
IIb Pain-free, claudication walking <200 m
III Rest pain
IV ulcer / gangrene
Stage III and IV “critical limb ischaemia”
10. G
r
Ca
t
Clinical description Objective criteria
0 0 Asymptomatic Normal treadmill or reactive hyperemia
test
1 Mild claudication Completes treadmill exercise; AP after
exercise > 50 mm Hg but at least 20 mm Hg
lower than resting value
I 2 Moderate claudication Between categories 1 and 3
3 Severe claudication Cannot complete standard treadmill
exercise, and AP after exercise < 50 mm Hg
II 4 Ischemic rest pain Resting AP < 40 mm Hg, flat or barely
pulsatile ankle or metatarsal PVR;
TP < 30 mm Hg
III 5 Minor tissue loss—
nonhealing ulcer, focal
gangrene
Resting AP < 60 mm Hg, ankle or
metatarsal PVR flat or barely pulsatile;
TP < 40 mm Hg
6 Major tissue loss—
extending above TM level,
no longer salvageable
Same as above
12. Grade Ulcer Gangrene
0 No ulcer No gangrene
.
1
Small, shallow ulcer on distal leg or
foot; no exposed bone, unless
limited to distal phalanx
No gangrene
2
Deeper ulcer with exposed bone,
joint, or tendon; generally
not involving the heel; shallow heel
ulcer, without calcaneal involvement
Gangrenous changes limited to
digits
3
Extensive, deep ulcer involving
forefoot and/or midfoot; deep, full-
thickness heel ulcer ± calcaneal
involvement
Extensive gangrene involving
forefoot and/or midfoot; full-
thickness heel necrosis ±
calcaneal involvement
13. Grade ABI Ankle systolic pressure TP, TcPo2
0 ≥0.80 >100 mm Hg ≥60 mm Hg
1 0.6-0.79 70-100 mm Hg 40-59 mm Hg
2 0.4-0.59 50-70 mm Hg 30-39 mm Hg
3 ≤0.39 <50 mm Hg <30 mm Hg
14. Clinical manifestation of infection SVS
No symptoms or signs of infection 0
Infection present, as defined by the presence of at least two of the
following items:•Local swelling or induration•Erythema >0.5 to ≤2 cm
around the ulcer•Local tenderness or pain•Local warmth•Purulent
discharge (thick, opaque to white, or sanguineous secretion)
1
Local infection (as described above) with erythema >2 cm or involving
structures deeper than skin and subcutaneous tissues (eg, abscess,
osteomyelitis, septic arthritis, fasciitis) and no systemic inflammatory
response signs (as described below).
2
Local infection (as described above) with the signs of SIRS, as
manifested by two or more of the following:•Temperature >38°C
or <36°C•Heart rate >90 beats/min•Respiratory rate >20 breaths/min
or Paco2 <32 mm Hg•White blood cell count >12,000 or <4000
cells/mm3
or 10% immature (band) forms
3
15.
16. ABPI = P(Leg) / P(Arm)
P (leg) - higher systolic blood pressure of dorsalis pedis or posterior tibial
arteries
P (Arm) - highest of the left and right arm brachial systolic blood pressure
ABPI < 0.9 - Abnormal
17. In symptomatic patients when
Revascularization planned
Arterial duplex ultrasound
CTA
MRA
Contrast arteriography /DSA
18. USS + DOPPLER
Visualise the vessels, stenosis, plaques
Flow and its quality
Non invasive
Good for infrainguinal vessels
Abdomial vessels – bowel gas
28. Indications for intervention
1. Disabling claudication
2. Rest pain
3. Tissue loss
Rutherford 4, 5, and 6 /
Fontaine III, IV
29. Smoking cessation
Statin therapy
Optimizing diabetes control (hemoglobin A1c
goal of <7.0%)
Antiplatelet therapy with Aspirin (75-325 mg
daily)
30. 3-month trial of Cilostazol (100 mg twice daily)
to improve pain-free walking (In patients with
IC who do not have congestive heart failure )
Trial of Pentoxifylline (400 mg thrice daily) (In
patients with IC who cannot tolerate or have
contraindications for Cilostazol )
31. • Supervised exercise program - minimum
of three times per week (30-60
min/session) for at least 12 weeks
• For patients who have undergone
revascularization -adjunctive functional
benefits
32. Does he have a Critical limb ischemia (CLI)
Yes
33. First defined - 1982.1
Intended to apply on patients without diabetes
An ankle pressure (AP) of
<40 mm Hg and rest pain
<60 mm Hg and tissue necrosis
Rutherford 4, 5, and 6 / Fontaine III, IV
34. Diabetic patients have a varied clinical picture
due to neuropathy and sepsis
35. Endovascular procedures is recommended
over open surgery for focal AIOD
In all patients undergoing revascularization
assessment of CFA and correction of
hemodynamically significant stenosis is
recommended.
36. SFA - Focal occlusive disease not involving the origin
– endo vascular.
Surgical bypass for;
Diffuse disease
Extensive calcification
Favorable anatomy for bypass ( e.g good runoff)
Low operative risk.
Saphenous vein is preferred conduit for infrainguinal
bypass
37. In patients undergoing infrainguinal
endovascular intervention - aspirin and
clopidogrel for at least 30 days
Significant graft stenosis – need reintervention
(open or endovascular) to promote long-term
patency
38. TASC II 2007: Europ J Vasc Endovasc Surg 2007:33(S1):S52
A
Endovascular
is procedure
of choice
B
Endovascular
is preferred
therapy
C
Surgery is
preferred for
good-risk
D
Surgery is
procedure of
choice
39. TASC II 2007: Europ J Vasc Endovasc Surg 2007:33(S1):S58
A
Endovascular
is procedure
of choice
D
Surgery is
procedure of
choice
B
Endovascular
is preferred
therapy
C
Surgery is
preferred for
good-risk
42. 30 day morbidity and mortality higher in
surgery
However after 2 years bypass strategy was
associated with a significant increase in
subsequent OS and a trend towards improved
AFS.