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Basic Principles of Vascular Surgery 2

This document discusses the basic principles of vascular surgery including anatomy, physiology, pathology, clinical presentation, investigation, and management of vascular conditions. It covers vascular pathology such as atherosclerosis and risk factors. Examination techniques are outlined examining pulses, skin changes, ulcers, and gangrene. Medical management focuses on risk factor control while surgical options include embolectomy, bypass grafting and amputation.

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danebros
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300 views21 pages

Basic Principles of Vascular Surgery 2

This document discusses the basic principles of vascular surgery including anatomy, physiology, pathology, clinical presentation, investigation, and management of vascular conditions. It covers vascular pathology such as atherosclerosis and risk factors. Examination techniques are outlined examining pulses, skin changes, ulcers, and gangrene. Medical management focuses on risk factor control while surgical options include embolectomy, bypass grafting and amputation.

Uploaded by

danebros
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Basic principles of vascular

surgery
 Anatomy
 Physiology
 Pathology
 Pathophysiology
Clinical presentation.History, physical
exam.
investigation
management
physiology
 Haemostasis vasoconstriction
 platelet
aggregation
 Coagulation intrinsic, extrinsic
 Fibrinolysis
 Renin angiotensin system
Vascular pathology
 Atherosclerosis: placque
formation,flow
 effect, fate of the
placque
 Risk factors
 Clinical sequelae : stenosis, occlusion,
 thrombosis,
embolisation,
 aneurysm
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
symptomatology
Chief complaint, history of the
present illness

 Peripheral vascular symptoms

 atherosclerosis risk factors

 Review of important systems


Peripheral vascular
symptoms
 Acute ischaemia
 Chronic ischaemia
 Infection
 Neuropathy
 Foot trauma/injury
 Syndromes amaurosis fugax,
dysphagia lusoria, Leriche , TIA, CVA
Atherosclerosis risk factors
 Nonmodifiable age , gender , family

 Modifiable D.M., Hypertension, Smoking

Dyslipidaemia, obesity,
stress
Review of systems
 Cardiac

 Cerebral

 Renal

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

 Pulse, B.P., Edema


 Local inspection
Colour elevation,
dependency
Skin trophic changes
Driness, hair, nails,
wasting
venous filling
Ulcers , Gangrene
Ulcers def., types
Gangrene
infarction
Necrosis
Examination
 Palpation temp. pulses, cap. Filling

 Auscultation carotid , femoral


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

1-Risk factors control

2-improve blood flow


aspirin, pentoxyphylline
clopidogrel, anticoagul.
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
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

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