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ARTERIAL OCCLUSIONDr. Rehan Ahmed KhanFCPS, FRCS, MHPE

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Arterial Occlusion

Arterial anatomy

Etiology of occlusion

Pathophysiology

Clinical features

Investigations

Treatment

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Etiology

Diabetes

Smoking

Hypertension

Obesity

High cholesterol levels

Males

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Symptoms produced

Lower limb

Claudication

Rest pain

Gangrene

Brain

TIA

Stroke

Kidney

Hypertension

Renal failure

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Angina

Infarction

Myocardium

Abdominal paininfarction

Intestine

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Features of arterial occlusion in the

leg

It is a cramp like pain felt in the

muscles that is

Brought on walking

Not present on taking the first

step

Relieved by standing still

Commonly felt in the calf but it

can affect the thigh or buttock

Intermittent

claudication

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Pain in leg at rest

Exaggerated by lying

down or elevation of

the foot

Pain is worse at night

Rest

pain

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Affected legs blanch on

elevation and develop a

purple discoloration on

dependency

Coldness,

numbness,paraesthesia

and color change

Painful erosion between toes

or as a shallow, non healing

ulcers on the dorsum of the

feet, on the shins, maleolli

Ulceration and

gangrene

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Foot is usually cold

But may equilibrate withthe surrounding

temperature

Acute ischeamic- frequently

paralysed and insensate Chronic ischaemia-

Temperaturesensation

and

movement

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Absent

Diminished in case of collaterals

Normal with highly develop collateral circulation

Phenomenon of disappearing pulse

Arterial

pulsations

Bruit indicates turbulence suggesting stenosisArterial

bruits

Limb elevated for 30s and then laid flat.

Slow refilling indicates arterial insufficiency

Venous

refilling

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Relationship of clinical findings to

site of disease

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Investigation of arterial occlusive

disease

Generalinvestigation

ABPI

Doppler

ultrasound

blood flowdetection

Duplex

imaging

Treadmill

Arteriography

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General investigations

Sugar levels

Lipid profile

Hb level

ECG

Echocardiography

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ANKLE BRACHIAL PRESSURE

INDEX First, bilateral arm and ankle systolic BP is measured; because

ankle pulses may be difficult to palpate, a Doppler probe may

be placed over the dorsalis pedis or posterior tibial arteries

PAD = ABPI Less than or equal to 0.90

Mild = 0.7-0.9

Moderate = 0.41 0.7

Severe = less than or equal to 0.40

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Doppler ultrasound and blood flow

detection

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Duplex Imaging

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Arteriography

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Non-surgical managment

General

Walk (spontaneous improvement occurs in many patients over 6

months after the 1st occlusive episode)

Exercise

Stop smoking

Dietary advice

Care of the ischemic foot

Drugs

Antidiabetic medications Antihypertesive medications

Statins

Antiplatelet

Newer drugs as cilostazol

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Surgical options

Transluminal Angioplasty and stenting

By pass operations

OCCLUSION BY PASS OPERATIONAortoiliac Aortofemoral

Femorofemoral

Ileofemoral crossover

axillobifemoral

Femoral artery Femoropopliteal

Below the popliteal artery femorotibial

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6 month

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