Peripheral arterial disease (PAD) is characterized by occlusions or stenoses of the lower extremity arteries. Symptoms include intermittent claudication, ischemic rest pain, skin ulceration, and gangrene. Evaluation involves physical exam of leg pulses and imaging tests like CTA or MRA. Treatment options include medical management, endovascular procedures like angioplasty and stenting, and surgical interventions like bypass surgery or amputation. Acute arterial occlusion can be caused by thrombosis, embolism, trauma, or aneurysm and requires urgent treatments like embolectomy or thrombolytic therapy to prevent limb loss and systemic complications.

1. ‫خدا‬ ‫نام‬ ‫به‬
 Anatomy of Artery
 Peripheral Arterial Disease
 Acute Arterial Occlusion

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

12. ARTERIAL ULCER

13.  Dry gangrene wet gangrene

14.  Evaluation:
 Physical Exam:
 1-Femoral artery
 2-popliteal artery
 3-Dorsalis pedis artery
 4-posterior tibial artery

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

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