Diseases of Arterial SystemDiseases of Arterial System1. Introduction & History.2. Anatomy.3. Physiology.4. Acute Arterial Occlusion.5. Ischemia Chronic Arterial Occlusion.6. Buerger’s Disease7. Aneurysms.8. Vasospastic Diseases.

Diseases of Arterial SystemDiseases of Arterial System

9.Gangrene, Pregangrene &Amputations.10.Vasular Problems of Upper Limbs11.Thoracic Outlet Syndrome.12.AV Fistula.13.Examination of Arterial System.14.Investigations of Arterial System.

Acute Arterial Occlusion Acute Arterial Occlusion EtiologyEtiology

Intrinsic:• Embolism• Thrombosis

Extrinsic:• Trauma

Embolism Embolism

-A body foreign to blood streamTo LLs is 10 times more common than ULNearly half of all emboli lodge at common

femoral bifurcation.

Embolism:CausesEmbolism:Causes

1.Atrial Fibrillation with Mitral Stenosis -rough surface with dyskinesia.2.Myocardial Infarction: rough surface with

dyskinesia. 3.Left Atrial Myxoma.4.Congenital and Rheumatic Valvular

deformities.5.Prosthetic Heart Valves.

Embolism:Causes Embolism:Causes

6.Arterio-arterial emboli:-ThrombusFibrinPlateletsCholesterol

Embolism:CausesEmbolism:Causes

7.Iatrogenic: Catheter ComplicationsA.Tip may dislodge:mural thrombusvalvular vegetationsplaquesB.ThrombiC.Air

Embolism:CausesEmbolism:Causes

8.Tumor9.BulletParadoxical Embolism

EtiologyEtiology

Intrinsic:• Embolism• Thrombosis

Extrinsic:• Trauma

ThrombosisThrombosis

1.Arteriosclerotic narrowing2.Atheromatous plaques3.Aneurysms4.Aortic dissection

Arterial Thrombosis:CausesArterial Thrombosis:Causes

5.Arteriopathies:Buerger’s diseasePeriarteritis NodosaFibro muscular DysplasiaTakayasu’s Disease

Arterial Thrombosis:CausesArterial Thrombosis:Causes

6.Hematologic:ThrombocytosisPolycythemiaDICErgotamine InfectionsMalignancies.

EtiologyEtiology

Intrinsic:• Embolism• Thrombosis

Extrinsic:• Trauma

Acute Arterial OcclusionAcute Arterial Occlusion Extrinsic Causes Extrinsic Causes

Trauma:To VesselTo surrounding soft tissues

Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma

Direct TraumaLacerationTotal transectionContusionIatrogenic: Catheterization

Long bone fracture

Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma

Long bone fracturesAngulationLacerationContusion

Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma

Long bone fracturesSupracondylar FractureFracture HumerusFracture PatellaFracture Clavicle

Acute Arterial OcclusionAcute Arterial Occlusion Trauma Trauma

-Compartment Syndrome-Popliteat Artery entrapment (Between medial

head of Gastrocnemius and medial condyle of femur)

-Rarely tumors may invade the artery.-Electrocution

Acute Arterial Occlusion Acute Arterial Occlusion Clinical FeaturesClinical Features

5Ps: Pain Pallor Parasthesia/Anesthesia Paralysis PulselessLimb is coldBleeding in trauma

Acute Arterial OcclusionAcute Arterial OcclusionDiagnostic StudiesDiagnostic Studies

Careful History taking and physical examination

History1.Trauma2.Atrial fibrillation, Mitral Stenosis3.H/O similar event4.Myocardial Infarction

Acute Arterial OcclusionAcute Arterial OcclusionDiagnostic StudiesDiagnostic Studies

Special Investigations1.Doppler ultrasound2.Duplex imaging3.Angiography/DSA4.X-Ray chest,ECG,Echo(Normalization of rhythm may

dislodge thrombus)5.Coagulogram6.MR Angiography7.Angioscopy.

Acute Arterial OcclusionAcute Arterial OcclusionDifferential DiagnosisDifferential Diagnosis

Difficult to differentiate Embolic from Thrombotic occlusion

1.DVT byEdemaParalysisfull veins

Phlegmesia alba dolens-Arterial flow -ntPhlegmesia cerulea dolens-Arterial flow +nt

Acute Arterial OcclusionAcute Arterial OcclusionDifferential DiagnosisDifferential Diagnosis

2.Aortic dissection3.Cardiac insufficiency4.Ergot intoxication5.Giant Cell Arteritis.

Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement

Surgery within 12 hours1.Embolectomy2.Vascular repair3.Venous grafting4.Prosthetic graft5.Intraarterial thrombolysis

Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement

Adverse effects of revascularisation:High feverMyoglobinuriaHyperkalemia >>> Cardiac arrestARF

Prevention is by Venotomy

Acute Arterial OcclusionAcute Arterial OcclusionManagementManagement

Medical TreatmentHeparinisationFibrinolytics- Streptokinase/UrokinaseTPA- Tissue Plasminogen Activator

Acute Arterial Occlusion Acute Arterial Occlusion

Complications:1.Gangrene 2.Secondary hemorrhage3.Volkmann’s Ischemic contracture4.A-V fistula5.False aneurysm6.Reperfusion complications