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السورية الخاصة الجامعة

البشري الطب كليةالجـراحـة قسم

قبطان عاصم الدكــتـورMD – FRCS

www.surgi-guide.com

2nd lecture

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Acute Arterial Occlusion

Definition :Is sudden occlusion of an artery

commonly caused by Emboli , or Thrombus .

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Definition

Embolus : Is an abnormal mass of undissolved material which is transported in the circulation from one part to another .

Thrombus : Is thrombotic lesion occurs on a plaque of pre-existing atheroma ending with complete acute occlusion of the artery .

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Classification of Embolism

1. Thrombi and clot may be bland or infected.

2. Gas : Air and Nitrogen .3. Fat .4. Tumour .5. Miscellaneous .

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Embolic Occlusion

It is often a thrombus that has become detached from the Lt Atrium in cardiac arrhythemia ( atrial fibrellation , or mural thrombus following myocardial infarction .

Less common are aneurysm and thrombi formed on atheromatous plaques causing artery to artery embolism .

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Clinical features of Arterial Occlusion It is an emergency and requires immediate

treatmentLeg >>>> pain , pallor >>>> parisis >>>>

pulslessness ,paraesthesia ( anaesthesia ) . The limb is cold and toes cannot be moved in

contrast with venous occlusion when muscle function is not affected .

The diagnosis can be made on clinical bases .Symptoms may progress to complete loss of

function , coldness and mottling.

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Types of embolism and complicationsCompartment syndrome .Intra-arterial thrombosis .Mesenteric artery occlusion .Air embolism .Bacterial infected clot embolism .Malignant cells ( Hypernephroma ,

Cardiac myxoma ) Fat embolism .Therapeutic embolisation.

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TreatmentTotal heparinisation ( Intravenous

Heparin 5000 U ) .Relief of pain since it is sever and

constant .Thrombolysis when indicated .Embolectomy .

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Abdominal Aortic Thrombosis

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Fogarty catheter for removal of Embolus

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Removal of organized thrombus

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Saddle Aortic Thrombosis

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Thrombus removed from SFA & POP A

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GANGRENE

Implies death of macroscopic portion of tissue

It is often affects distal part of limb because of arterial obstruction .

Gas gangrene caused by anaerobic infection .

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Clinical featuresAbsent arterial pulsation .Absent venous return.Absent capillary response to pressure .Absent sensation .Absent warmth .Absent function .Changes in colour : Pallor , duscky

grey ,mottled , purple >>> dark-brown , greenish-black ,black.

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Types of gangrene

Dry gangrene .Moist gangrene the affected part

becomes swollen ,and discoloured . Crepitus may be palpated .this condition is quite common in feet of diabetics.

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Specific varaieties of gangree

Diabetic gangrene .Bedsores .Drug abuse .Injecting of drugs into arteries .Frost bite .Venous gangrene

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Frostb

ite of

the f

oot

note

the c

lear d

emarc

ation

line

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Treatment of gangrene

According to stage .In diabetic gangrene : Oxygenation ,

Antibiotics ,Extensive debridement.Amputation .