Lectures notes for medical students

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2. Diseases of Arterial System

3. Diseases of Arterial System
1. Introduction & History.
2. Anatomy.
3. Physiology.
4. Acute Arterial Occlusion.
5. Ischemia Chronic Arterial Occlusion.
6. Buerger’s Disease
7. Aneurysms.
8. Vasospastic Diseases.

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

5. Acute Arterial Occlusion
Etiology

6. Acute Arterial Occlusion
Etiology
• Intrinsic:
• Embolism
• Thrombosis
• Extrinsic:
• Trauma

7. Embolism
• A body foreign to blood stream
• To LLs is 10 times more common than UL
• Nearly half of all emboli lodge at common
femoral bifurcation.

8. Embolism: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.

9. Embolism:Causes
6.Arterio-arterial emboli:-
• Thrombus
• Fibrin
• Platelets
• Cholesterol

10. Embolism:Causes
7.Iatrogenic: Catheter Complications
A.Tip may dislodge:
mural thrombus
valvular vegetations
plaques
B.Thrombi
C.Air

11. Embolism:Causes
8.Tumor
9.Bullet
Paradoxical Embolism

12. Etiology
Intrinsic:
• Embolism
• Thrombosis
Extrinsic:
• Trauma

13. Thrombosis

14. Thrombosis
1.Arteriosclerotic narrowing
2.Atheromatous plaques
3.Aneurysms
4.Aortic dissection

15. Arterial Thrombosis:Causes
5.Arteriopathies:
Buerger’s disease
Periarteritis Nodosa
Fibro muscular Dysplasia
Takayasu’s Disease

16. Arterial Thrombosis:Causes
6.Hematologic:
Thrombocytosis
Polycythemia
DIC
Ergotamine
Infections
Malignancies.

17. Acute Arterial Occlusion
Extrinsic Causes
Trauma:
• To Vessel
• To surrounding soft tissues

18. Acute Arterial Occlusion
Trauma

19. Acute Arterial Occlusion
Trauma
• Direct Trauma-
• Laceration
• Total transection
• Contusion
• Iatrogenic: Catheterization
• Long bone fracture-

20. Acute Arterial Occlusion
Trauma
• Long bone fractures
• Angulation
• Laceration
• Contusion

21. Acute Arterial Occlusion
Trauma
• Long bone fractures-
• Supracondylar Fracture
• Fracture Humerus
• Fracture Patella
• Fracture Clavicle

22. Acute Arterial Occlusion
Trauma
• -Compartment Syndrome
• -Popliteat Artery entrapment (Between
medial head of Gastrocnemius and medial
condyle of femur)
• -Rarely tumors may invade the artery.
• -Electrocution

23. Acute Arterial Occlusion Clinical
Features

24. Acute Arterial Occlusion Clinical
Features
History-
1.Trauma
2.Atrial fibrillation, Mitral Stenosis
3.H/O similar event
4.Myocardial Infarction

25. Acute Arterial Occlusion
Clinical Features
6Ps of Acute Arterial Occlusion :-
1. Pain
2. Pallor
3. Parasthesia/Anesthesia
4. Paralysis
5. Pulseless
6. Poikilothermia -Limb is cold
Bleeding in trauma

26. Acute Arterial Occlusion
Diagnostic Studies

27. Acute Arterial Occlusion
Diagnostic Studies
Special Investigations-
1.Doppler ultrasound
2.Duplex imaging
3.Angiography/DSA
4.X-Ray chest,ECG,Echo(Normalization of rhythm may
dislodge thrombus)
5.Coagulogram
6.MR Angiography
7.Angioscopy.

28. Acute Arterial Occlusion
Differential Diagnosis
Difficult to differentiate Embolic from
Thrombotic occlusion
1.DVT by
Edema
Paralysis
full veins
Phlegmesia alba dolens-Arterial flow -nt
Phlegmesia cerulea dolens-Arterial flow +nt

29. Acute Arterial Occlusion
Differential Diagnosis
2.Aortic dissection
3.Cardiac insufficiency
4.Ergot intoxication
5.Giant Cell Arteritis.

30. Acute Arterial Occlusion
Management

31. Acute Arterial Occlusion
Management
Surgery within 12 hours-
1.Embolectomy
2.Vascular repair
3.Venous grafting
4.Prosthetic graft
5.Intraarterial thrombolysis

32. Acute Arterial Occlusion
Management
Adverse effects of revascularisation:
High fever
Myoglobinuria
Hyperkalemia >>> Cardiac arrest
ARF
Prevention is by Venotomy

33. Acute Arterial Occlusion
Management
• Medical Treatment
Heparinisation
Fibrinolytics- Streptokinase/Urokinase
TPA- Tissue Plasminogen Activator

34. Acute Arterial Occlusion

35. Acute Arterial Occlusion
Complications:
1.Gangrene
2.Secondary hemorrhage
3.Volkmann’s Ischemic contracture
4.A-V fistula
5.False aneurysm
6.Reperfusion complications

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