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Basic principles of vascular surgery

Basic principles of vascular surgery

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Basic principles of vascular surgery

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  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