1 / 21

Basic principles of vascular surgery

Basic principles of vascular surgery. Anatomy Physiology Pathology Pathophysiology Clinical presentation.History, physical exam. investigation management. physiology. Haemostasis vasoconstriction platelet aggregation Coagulation intrinsic, extrinsic

melvyn
Télécharger la présentation

Basic principles of vascular surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Basic principles of vascular surgery • Anatomy • Physiology • Pathology • Pathophysiology Clinical presentation.History, physical exam. investigation management

  2. physiology • Haemostasis vasoconstriction • platelet aggregation • Coagulation intrinsic, extrinsic • Fibrinolysis • Renin angiotensin system

  3. Vascular pathology • Atherosclerosis: placque formation,flow • effect, fate of the placque • Risk factors • Clinical sequelae : stenosis, occlusion, • thrombosis, embolisation, • aneurysm

  4. Vascular pathology 1-Trauma:RTA,falls, stabs, gun shot, sharps Iatrogenic DRUG ADDICT 2-Inflammatory: (VASCULITIS) Takayassaue, Kawasaki, Beurger Connective tissue (SLE, polyart. Nod., Rh. Art.,) 3-Spasmodic Reynauds dis., phenomenon 4-Conginetal malformation : venous, arterial AVM

  5. symptomatology Chief complaint, history of the present illness • Peripheral vascular symptoms • atherosclerosis risk factors • Review of important systems

  6. Peripheral vascular symptoms • Acute ischaemia • Chronic ischaemia • Infection • Neuropathy • Foot trauma/injury • Syndromes amaurosis fugax, dysphagia lusoria, Leriche , TIA, CVA

  7. Atherosclerosis risk factors • Nonmodifiable age , gender , family • Modifiable D.M., Hypertension, Smoking Dyslipidaemia, obesity, stress

  8. Review of systems • Cardiac • Cerebral • Renal • Gastrointestinal

  9. Renovascular hypertension • 10-20%of secondary hypertension • Uncontrolled despite 2-3 meds • Flash pul.oedema • Hypokalaemia • Captopril test • Doppler US., MRA • Angioplasty

  10. Examination • Pulse, B.P., Edema • Local inspection Colour elevation, dependency Skin trophic changes Driness, hair, nails, wasting venous filling Ulcers , Gangrene

  11. Ulcers def., typesGangreneinfarction Necrosis

  12. Examination • Palpation temp. pulses, cap. Filling • Auscultation carotid , femoral

  13. Investigation • Bood work, ECG, CXR • Non invasive vascular lab ankle/brachial index exercise test , toe pressure doppler ultrasound Invasive angiography, CT, MRA

  14. Medical Management 1-Risk factors control 2-improve blood flow aspirin, pentoxyphylline clopidogrel, anticoagul.

  15. Aspirin mechanism of action Phosphlipids---arachidonic acid----(cyclo-oxygena)--endoperoxides: In plt. --------thromboxane(throm.synth) ATP-----ADP(plt aggreg.+vasocons) In blood vessel endoth. Endoperox.----prostacyclin(stimulate adenyl cyclase) ATP------cAMP(plt sgreg.+vasodil) -----5AMP (phosphodiesterase)

  16. Surgical management • For rest pain, ulcers, gangrene • Embolectomy , thrombectomy, • Vascular reconstruction Endart.,repair, resection+interposition,Bypass Using saphenous vein (reverse/insitu)or PTFE • Amputation toe, transmet., symes,BK,AK

More Related