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- 1. 15-03-2018 1 ARTERIAL DISORDERSAN INSIGHT
- 2. ANATOMY • ARTERIES OFUPPER LIMB • ARTERIES OF LOWER LIMB 15-03-2018 2
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- 6. 15-03-2018 6 LAYERS OFARTERY • TUNICA ADVENTITIA • TUNICA MEDIA • TUNICA INTIMA
- 7. ARTERIAL PULSES PULSE WHERE?AGAINST? DORSALIS PEDIS LATERAL TO EXTENSOR HALLUCIS LONGUS TENDON AT PROXIMAL END OF FIRST WEB SPACE. NAVICULAR AND MIDDLE CUNEIFORM BONES POSTERIOR TIBIAL ARTERY BEHIND MEDIAL MALLEOLUS MIDWAY BETWEEN IT AND ACHILLES TENDON CALCANEUM ANTERIOR TIBIAL ARTERY LATERAL TO EXTENSOR HALLUCIS LONGUS TENDON, ABOVE THE ANKLE JOINT, BETWEEN BOTH MALLEOLI LOWER END OF TIBIA POPLITEAL ARTERY LOWER PART OF POPLITEAL FOSSA FLAT POSTERIOR SURFACE OF UPPER END OF TIBIA FEMORAL ARTERY JUST BELOW INGUINAL LIGAMENT MIDWAY BETWEEN ASIS AND PUBIC SYMPHYSIS UPPER END OF FEMUR 15-03-2018 7
- 8. 15-03-2018 8 PULSE WHERE?AGAINST? RADIAL ARTERY LATERAL ASPECT OF WRIST LOWER END OF FRONT OF RADIUS ULNAR ARTERY MEDIAL ASPECT OF WRIST LOWER END OF FRONT OF ULNA BRACHIAL ARTERY FRONT OF ELBOW MEDIAL TO BICEPS TENDON LOWER END OF HUMERUS AXILLARY ARTERY APEX OF AXILLA SHAFT OF HUMERUS SUBCLAVIAN ARTERY JUST ABOVE THE MIDDLE OF CLAVICLE FIRST RIB COMMON CAROTID ARTERY MEDIAL TO STERNOCLEIDOMASTOID MUSCLE AT THE LEVEL OF THYROID CARTILAGE CAROTID TUBERCLE OF TRANSVERSE PROCESS OF C6 CERVICAL VERTEBRA FACIAL ARTERY INSERTION OF MASSETER BODY OF MANDIBLE SUPERFICIAL TEMPORAL ARTERY FRONT OF TRAGUS OF EAR ZYGOMATIC BONE ARTERIAL PULSES
- 9. CLINICAL TESTS 1. HARVEY’SSIGN – DELAYED VENOUS REFILLING 2. FUCHSIG’S TEST – POPLITEALARTERY STENOSIS 3. DISAPPEARING PULSE SYNDROME 4. BUERGER’S POSTURAL TEST – ANGLE <30 INDICATES SEVERE ISCHAEMIA 5. ADSON’S TEST- CERVICAL RIB / SCALENUS ANTICUS SYNDROME 6. EAST – THORACIC OUTLET SYNDROME 7. ALLEN’s TEST- RADIAL & ULNAR ARTERIES 8. FALCONER’S TEST- SUBCLAVIAN ARTERY 9. HYPERABDUCTION MANOEURVE 15-03-2018 9
- 10. CASE SCENARIO 1 A40 year old male, comes to the Emergency Department at 6 am with complaints of pain, inability to use both lower limbs since morning. On examination, cold, loss of peripheral pulses and loss of penile tumescence. Loss of sensation below the level of inguinal ligament. The patient is a known smoker for past 15 years. DIAGNOSIS? 15-03-2018 10
- 11. CASE SCENARIO 2 Apreviously healthy 40 year old woman comes to OPD with complaints of 6 month history of shortness of breath. Patient complaints of pulsatile tinnitus. She has reduced her running from 40min to 20 min at a slower pace. O/E BP – 130/60mm Hg, Pulse -96/min, RR- 16/min Peripheral pulses are bounding. Bruit heard over the upper part of neck. ECG- left ventricular hypertrophy. DIAGNOSIS? 15-03-2018 11
- 12. A 42 yearold male comes to Emergency Department with C/O Acute onset of shearing pain radiating to back while straining for stools. H/O chest Pain. On Examination Pulse UL - bounding. LL – weekly felt. DIAGNOSIS? 15-03-2018 12 CASE SCENARIO 3
- 13. ARTERIAL DISORDERS 1. STENOSIS 2.DILATATIONS (ANEURYSMS) 3. ARTERITIS 4. SMALL VESSEL ABNORMALITIES 15-03-2018 13
- 14. ARTERIAL STENOSIS INTERMITTENT CLAUDICATION RESTPAIN LIMB ISCHEAMIA PRE-GANGRENE GANGRENE 15-03-2018 14
- 15. Boyd’s classification ofClaudication Grade I – pain after walking, if continued walking pain subsides. Grade II – Pain still persists on continuing walking, but can walk with effort. Grade III – Takes rest to relieve pain. CAUSES 1. Arterial 2. Neurogenic 3. Venous 15-03-2018 15
- 16. GANGRENE 1. Dry gangrene 2.Wet gangrene 3. Gas Gangrene Organs in which gangrene may develop – Appendix, Bowel, Gall Bladder, Testis, Pancreas. Specific types: 1. Diabetic Gangrene 2. Bedsores 3. Frostbite 15-03-2018 16
- 17. Ankle brachial pressureIndex Ratio of systolic pressure in ankle to systolic pressure in arm. Highest value is taken. Normal – 1.0 <0.9 – claudication <0.5 – rest pain <0.3 – imminent necrosis. 15-03-2018 17
- 18. THROMBOANGIITIS OBLITERANS • Non-atherosclerotic inflammatorydisorder • Medium sized, distal vessels • Cell mediated sensitivity to T-I & T-III collagen. • Involvement of ARTERY, VEIN and NERVE. 15-03-2018 18
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- 20. THROMBOANGIITIS OBLITERANS Smoking index Noof cigars/day x no of years (>300 high risk ) Pack year index no of years of smoking x no of cigar packets per day ( >40 HIGH RISK ) 15-03-2018 20
- 21. TAKAYASU ARTERITIS • Pulselessdisease • Involves aortic arch • Incidence - 2.6 cases/million/year • Features • Upper limb claudication • Absent pulses • Thrill/bruit along major arteries • Optic nerve atrophy 15-03-2018 21
- 22. RAYNAUD’S PHENOMENON • Episodicvasospasm • Primary and secondary types • Raynauds syndrome Local syncope Local asphyxia Local recovery Local gangrene 15-03-2018 22
- 23. • Bilateral • Females •Recurrence • Peripheral pulses felt • Medial 4 digits involved; thumb is spared. 15-03-2018 23 RAYNAUD’S PHENOMENON
- 24. C- calcinosis cutis R-raynaud’s PHENOMENON E- esophageal defects S- sclerodactyly T- telangiectasia Vibration white finger Collagen vascular diseases 15-03-2018 24 RAYNAUD’S PHENOMENON
- 25. Investigations • Angiogram • X-rayhand, anti-nuclear antibody assay • Segmental blood pressure gradient • Cold recovery time • Routine investigations Treatment • Treat cause • Avoid precipitants • LOW DOSE ASPIRIN 75mg • NIFEDIPINE 20mg • Steroids 15-03-2018 25 RAYNAUD’S PHENOMENON
- 26. ANEURYSM • Abnormal permanentdilatation of a localized segment • True/false • Fusiform / saccular / dissecting • Etiology: • Degenerative/ traumatic/infective/ collagen disease • Berry aneurysm / congenital AV fistula 15-03-2018 26
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- 28. • Clinical features •Pulsatile swelling • Smooth/warm/compressible/thrill/bruit • Distal edema • Altered sensation • Embolus Classification I - infrarenal/suprarenal II- asymptomatic / symptomatic/symptomatic ruptured 15-03-2018 28 ANEURYSM
- 29. Complications Rupture, infection Thrombosis, embolism Distalischaemia, gangrene Fistula Erosion of vertebra 15-03-2018 29 ANEURYSM
- 30. Rupture 1. Early diagnosis 2.Immediate resuscitation 3. Permissive hypotension 4. Urinary catheter 5. Cross match 6 units blood 6. Rapid transfer to operating room. 15-03-2018 30 ANEURYSM
- 31. Operative procedure foraneurysm • Open surgical procedure • Endovascular aneurysm repair 15-03-2018 31 ANEURYSM
- 32. ARTERIOVENOUS FISTULA • Communicationbetween artery and vein. • Congenital / acquired • Structural effect • Physiological effect Clinically:- • Pulsatile swelling • Thrill/ bruit Investigations: Duplex scan / angiography Management - Embolisation 15-03-2018 32
- 33. CASE SCENARIO 1 A40 year old male, comes to the Emergency Department at 6 am with complaints of pain, inability to use both lower limbs since morning. On examination, cold, loss of peripheral pulses and loss of penile tumescence. Loss of sensation below the level of inguinal ligament. The patient is a known smoker for past 15 years. DIAGNOSIS? 15-03-2018 33
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- 35. CASE SCENARIO 2 Apreviously healthy 40 year old woman comes to OPD with complaints of 6 month history of shortness of breath. Patient complaints of pulsatile tinnitus. She has reduced her running from 40min to 20 min at a slower pace. O/E BP – 130/60mm Hg, Pulse -96/min, RR- 16/min Peripheral pulses are bounding. Bruit heard over the upper part of neck. ECG- left ventricular hypertrophy. DIAGNOSIS? 15-03-2018 35
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- 37. A 42 yearold male comes to Emergency Department with C/O Acute onset of shearing pain radiating to back while straining for stools. H/O chest Pain. On Examination Pulse UL - bounding. LL – weekly felt. DIAGNOSIS? 15-03-2018 37 CASE SCENARIO 3
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- 39. REFERENCES • BAILEY ANDLOVE SHORT PRACTICE OF SURGERY 26TH EDITION • DAS -MANUAL OF CLINICAL SURGERY • INTERNET FOR PICTURES. 15-03-2018 39
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