Acute arterial occlussion
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Transcript of Acute arterial occlussion
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