Presentation on theme: "ARTERIAL DISEASES Objectives:"— Presentation transcript:
1 ARTERIAL DISEASES Objectives: TO UNDERSTAND THE NATURE OF OCCLUSIVE ARTERIAL DISEASE AND ITS ASSOCIATED SYMPYOMS AND SIGNSTO ABLE TO ASSESS ACUTE AND CHRONIC ARTERIAL INSUFFICIENCY AND KNOW TREATMENT OPTIONS.TO KNOW ABOUT GANGRENE AND ITS MANAGEMENTTO KNOW OTHER ARTERIAL DISEASES LIKE ANEURYSMS,ARTERITIS AND VASOSPASTIC DISEASES & AVFistula
6 ACUTE ARTERIAL OCCLUSION-Embolism C/F FIVE PsPAINPARALYSISPALLORPULSELESSNESSPARAESTHESIA
7 Relation ship of symptoms to the site of obstruction Aorto-iliac obstructionIliac obstructionFemoro-popliteal obstructionDistal obstructionankle pulses absentCaludication in both buttocks,thighs & calves. Femoral & distal pulses absent in both limbs. Impotence.bruit over aortoiliac region.U/l claudication in thigh & calf buttocks.Bruits over iliac regionU/L absence of femoral or distal pulses.U/L claudication in calf. Femoral pulse palpable with absent u/l distal pulsesFemoral & Popliteal pulse palpableclaudication in calf & foot
14 Treatment. Embolic arterial occlusion is an emergency!!! THROMBOLYSIS – Immediate -Intra Venous Heparin 5000Uto prevent distal and proximal extension of thrombus.ContraindicationsRecent strokeActive peptic ulcerBleeding disordersPregnancyHydrationEMBOLECTOMYTHROMBECTOMY.
15 Fogarty catheterization- for removing proximal and distal extension of thrombus. Postoperatively- heparin and oral anticoagulationIntrarterial ThrombolysisOnly if ischemia is not so severe that immediate operation is mandatory, it is possible to treat thrombus or embolus by intra arterial thrombolysisAgents-TPA-tissue plasminogen activator**StreptokinaseUrokinaseIdentify and treat the basic cause.
19 Chronic Arterial Insufficiency EtiologyAtherosclerosisBuerger’s diseaseArtritisArterisclerosisDiabetesRisk FactorsHypertensionStrong family historySmokingLipid abnormalities
20 Chronic Limb IschemiaIschemia of the lower limb may be minimal to criticalAlso called Chronic arterial insufficiency orPeripheral Vascular disease-PVD.Clinical presentation-Intermittant Claudication-commonest complaint. Fatigue, aching or crampy pain occuring with exertion and relieved by rest, reproducible at the same distance.Claudication distance- distance at which the pain appearsRest painCritical ischemia- severe ischemia with actual or potential tisssue loss.
21 Signs of chronic ishemia Loss of muscle mass/bulkLoss of subcutaneous fatSkin shinyLoss of hairBrittle nailsGangrene and ulcers of foot.
23 GANGRENEDef: death, often with putrifaction of macroscopic portion of tissues.VARIETIES ACCORDING TO THE CAUSE-Secondary:Thrombus in atherosclerotic artery.ATRIAL FIBRILLATION-embolus.Arteritis from NEUROPATHYBUERGERS DISEASERAYNAUDS DISEASE/ERGOTISM- causing arterial shutdownINTRARTERIAL INJECTIONS- thiopentone & cytotoxic materials.
24 GANGRENEPrimary:INFECTIVE- boils, carbuncles, gas gangrene, gangrene of scrotum (Fournier’s gangrene)TRAUMATIC- crush, pressure sores & constriction groovesPHYSICAL- burns, scalds,frostbite,chemical irradiation & electricity.VENOUS-C/FPulseless,painnless,funtionless, with colour change.Lacks capillary refill and venous return.Black,brown, greenish black.
25 GANGRENE CLINICAL TYPES- DRY & MOIST DRY gangrene- dessicated tissues,part becomes dry and wrinkled. Wrinkled ,discolourd from disintegration of Hb. & greasy to touch.MOISTgangrene:when venous & arterial obstruction is present, when artery is suddenly occluded by a ligature or embolus & in diabetes..Infection & putrifaction is present.Part is swollen& discoloured.Crepitus may be present.
26 GANGRENE SEPERATION OF GANGRENE- SEPERATION BY DEMARCATION SEPERATION WITHOUT DEMARCATION.Vague DEMARCATION & skip lesions.TREATMENT OF GANGRENE-GENERAL PRINCIPLES- limb saving attitude.Cardiac failureAtrial fibrillation anaemia. Nutritious diet.Control of diabetes.Analgesics.LOCAL TREATMENT-dry.protection of pressure areas. Cleanniess.
27 VARIETIES OF GANGRENE DIABETIC GANGRENE- three factors- Trophic changes from peripheral neuritis.Atheroma of artries causing ischemiaExcess sugar –decreases resistance to infections esp. fungal infectionDIRACT TRAUMATIC GANGRENEBEDSORES-(Decubitus Ulcers) 5 factorsPressureInjuryAnemiaMalnutritionMoisture
29 Gangrene INDIRECT TRAUMATIC GANGRENE- Interference with blood vessels from pressure by a fractured bones/ strangulationThrombosis of an arteryLigation of an arterypoor technique for digital anesthesiaERGOT- claviceps purpurea.Fingers,nose & ears .Seen in migrane suffers.
30 PHYSICAL AND CHEMICAL CAUSE OF GANGRENE .FROST BITE- cold+wind. Damage to Vessel wall with transudation & edema. Pain initially later painless & gangreneTRENCH FOOT-cold+ moist+ muscular inactivity.Ill fitting boots.I/V INJECTION OF THIOPENTONEDRUG ABUSECHEMICAL GANGRENE- carbolic acid(phenol).
32 ANEURYSMSANEURYSMS- dilatation of a localised segment of the arterial system.True- all three layers involved.False- single layer of fibrinous tissue as the wall of the sac.According to the shape-fusiform-Saccular-DissectingEti0logy-traumatic/atherosclerotic/syphilitic/collagen disease(Marfan,syndrome), mycotic(bacterial)
34 ANEURYSMSSymptoms- due to expansion, thrombosis, rupture or release of emboli.Symptom relate to the vessel affected, the site supplies or the tissue compressed.Clinical featuresIntrinsic-expansile pulsation along the course of an artery. proximal compression decreases pulsationsPalpation- thrillAuscultation-bruits??Extrinsic- neighboring or distal structures are affected.NerveVeinsTubes-trachea ,esophagus
35 D/DSwelling under an artery- cervical rib(subclavian)Swelling over an artery-pancreatic cystPulsatile tumors-sarcoma,osteoclastoma & metastsis from hypernephroma.abscessserpentine artery- innominate,carotid.
43 AVF Clinical signs: Pulsatile swelling Thrill on palpation Bruits on ausculatationDilated veinsNicoladoni-Branham’s test- Decreased thrill, reduction in size and bradycardia on pressing the artery proximal to fistulaTreatmentEmbolizationLigation of feeding artery???Surgery- Separation of artery & vein
44 ARTERITIS Thromboangitis obliterans/ Buerger’s disease Small & medium sized arteries.Occlusive diseaseThrombophebitis of superficial/ deep veins.Raynauds syndrome, male, young patients
45 VASOSPASTIC CONDITIONS: Reynaud's syndrome:Primary/ idiopathic form.SecondaryPallor- blanchingBlue- cyanosisRedness-red engorgement.Accompanied by pain.Treatment - conservativeTab. nicotinamideSecondary Reynaud's syndrome-due to some other problem like-collagen disease, atherosclerosis, thoracic outlet syndrome, carpal tunnel syndrome