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thrombosis embolism.pptx
- 1. THROMBOSIS, EMBOLISm AND surgical treatment
- 2. Normal Haemostasis Process of maintaining blood in a fluid, clot – free state in normal vasculature and rapidly forming a localized haemostatic plug at the site of vascular injury The pathologic opposite of haemostasis is thrombosis
- 4. Thrombosis Formation of solid mass in circulation from the constituents of flowing blood with intact cardiovascular tree during life
- 5. RUDOLF VIRCHOW Coined the terms“THROMBOSIS” and “EMBOLISM”
- 7. Endothelial Injury Main cause for thrombus formation in the heart and the arterial circulation These are platelet – rich clots Inflammation Infection Toxins from cigarette smoking Hypercholesterolemia
- 9. Abnormal blood flow Turbulence • Arterial thrombosis • Atherosclerotic plaque Stasis • Venous thrombosis • Aortic aneurysm • Post MI – cardiac mural thrombi • Rheumatic mitral valve stenosis • Hype Poly rviscosity – cythemia vera
- 10. Hypercoagulability Thrombophilia Any disorder of blood that predisposes to thrombosis Hypercoagulable states are associated with VENOUS THROMBOSIS
- 11. Hypercoagulable states GENETIC Factor V mutation Increased levels of factor VIII, IX, XI or Fibrinogen ACQUIRED Pregnancy and Prolonged bed rest or immobilization Disseminated Cancer Prosthetic cardiac valves Disseminated intravascular coagulation Oral contraceptive use post partum
- 12. Arterial thrombi Venous thrombi Arteries and heart veins Aorta, coronary, cerebral etc Superficial varicose veins, deep leg veins Endothelial cell injury Causes-atherosclerosis, vasculitis, trauma Venous stasis Usually mural, not occluding lumen Invariably occlusive Grey- white, friable with lines of zahn Red-blue with fibrin strands with line of zahn Grows retrogrde Grows in the direction of blood flow Meshwork of platelets, fibrin, red cells and degenerating leucocytes More enmeshed RBC s and few platelets(red or stasis thrombi)
- 13. Antemortem thrombus Postmortem clot Adherent to wall Not adherent to vessel wall Red in colour Fibrin with red cells and leucocytes in a haphazard network (gelatinous) Upper layer resembling chicken fat Lines of zahn present No lines of zahn – bland and non – laminated
- 14. Lines of zahn
- 15. Mural thrombi
- 16. Vegetations – Thrombi on heart valves
- 18. Fate of thrombus Propagation Embolization – thrombi dislodges and travels to other sites in vasculature Dissolution – by fibrinolysis Organisation and recanalization Older thrombi become organised by ingrowth of endothelial cells, smooth muscle cells and fibroblasts. Capillary channels reestablish continuity of lumen
- 20. Embolism An embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from origin.
- 21. Classification Thromboembolism (most common) Fat embolism Air embolism Amniotic fluid embolism
- 22. Pulmonary embolism Embolus lodges in the lungs (most common from deep vein thrombosis) Systemic embolism extremities, kidneys, Brain, lower intestines, spleen(arterial emboli from valvular intracardiac mural or thrombi, aortic aneurysms, atherosclerotic plaques)
- 23. Pulmonary thromboembolism Cause from venous emboli from deep leg veins Common in hospitalisedand bed ridden patients Large thrombus gets impacted at bifurcation of pulmonary artery- saddle embolus Multiple emboli Paradoxical embolism
- 25. Fat embolism Obstruction of arterioles and capillaries by fat globules Fractures of long bones Trauma to soft tissue eg., adipose tissue Clinical features Pulmonary insufficiency - tachypnea, dyspnea, tachycardia Neurologic symptoms - irritability, restlessness to delirium and coma Thrombocytopenia
- 26. Fat embolism
- 27. Air embolism Gas bubbles within the circulation can coalesce to form frothy masses and obstruct vascular flow Large volume of air (more than 100 cc) is necessary to produce effect in pulmonary circulation Small volume of air trapped in coronary artery during bypass surgery Chest wall injury Obstetric or laproscopy procedures
- 28. Decompression sickness • Bends - formation of gas bubbles in skeletal muscles and joints producing pain - edema, focal • In lungs hemorrhages, atelectasis Caissons disease (chronic decompression sickness) - gas emboli in heads of femur, tibia and humeri.
- 29. Amniotic fluid embolism partum During labour or immediate post period Dyspnea, cyanosis, hypotensive shock, seizure and coma Infusion of amniotic fluid or fetal tissue into maternal circulation via tear in placental membranes or rupture of uterine veins
- 30. Methods of surgical treatment: • Surgery. Types of surgery to treat arterial thrombosis if it is blocking an artery to the heart include coronary artery bypass and carotid endarterectomy. In coronary artery bypass surgery, surgeons take a blood vessel from another part of the body to bypass the block. • injections of a medicine called a thrombolytic which can dissolve some blood clots. an operation to remove the clot (embolectomy) an operation to widen the affected artery – for example, an angioplasty (where a hollow tube is placed inside the artery to hold it open)
- 31. Surgical procedure to remove a blood vessel? • Thrombectomy and embolectomy can be performed using the following methods: non- invasive (no incisions required / small puncture / low to moderate sedation), minimally-invasive (small incisions of 2–3 inches long / general anesthesia), or through open-surgery (large incisions of 8-10 inches long / general anesthesia).