Arterial Disorders

Arterial Disorders

Introduction:
Arterial disease generally includes:
Coronary artery disease or ischemic heart disease
Cerebrovascular disease
Mesenteric ischemia
Renovascular disease
Peripheral arterial disease

Peripheral arterial disease:

What is peripheral arterial disease?

Peripheral arterial disease includes:

Chronic arterial occlusion
Acute arterial occlusion
Aneurysms
Arterio-venous malformations and fistulas


Chronic Arterial Occlusion

Atherosclerosis:

"Response to injury hypothesis“ by Ross.

Risk factors:

Smoking
Diabetes mellitus
Dyslipidemia
Hypertension
Obesity
Increase age

Clinical features:

• Intermittent claudication:
• Rest pain
• Coldness, numbness, paraesthesia and colour change.
• Ulceration and gangrene;
• Reduced sensation
• Motor weakness
• Absent or diminished pulses
• Arterial bruit

Investigations:

General investigation to diagnose associated disease:
• IHD, COPD, DM, renal disease, Lipid abnormalities, and Coagulation abnormalities.

Investigations for arterial mapping:

Doppler ultrasound
Duplex ultrasound
Peripheral angiography
CT angiography and MRA

Duplex ultrasound

Treatment:

Stop smoking
Control of blood sugar
Reduce blood lipid
Reduce weight
Regular exercise to the limit of claudication
Drugs:
Antiplatelets e.g.; aspirin, clopidogrel, …
Vasodilators e.g.; tolazoline, calcium canal blockers, pentoxifylline,

• I- Conservative Treatment:

II- Percutaneous Transluminal Angioplasty (PTA)

III- Surgical Treatment:

Surgical optoins:
• Bypass surgery
• Surgical endarterectomy
• Sympathectomy
• Amputation

Bypass Surgery

Endarterectomy:

Sympathectomy:

Dorsal Sympathectomy

Lumbar Sympathectomy

Acute Arterial Occlusion

Acute arterial occlusion:
Embolism

Thrombosis of an atheromatous plague

Arterial trauma

Embolic Arterial Occlusion

What is an embolus?


What is the most common source of an embolus?

What does an embolus cause?

Clinical presentation:
Depending on the site of obstruction:
Brain: stroke
Intestine: gangrene of corresponding loop of bowel
Spleen: splenic infarction and left hypochondrial pain
Kidney: loin pain and hematuria
Limbs: (6P)
pain,
pallor,
paresis,
purchasing cold,
pulselessness
paraesthesia

Diagnosis and investigations:

Usually a clinical diagnosis

Confirming investigations include:

Doppler
Duplex ultrasound
Peripheral angiography
CT angiography or MRA

Treatment:

• Heparin
• Relieve pain
• Emergency embolectomy

Embolectomy catheter

Acute arterial thrombosis:

Sudden occlusion of an already atherosclerosed artery
Acute on chronic ischemia
Similar presentation to emboli but less severe. Why?
Arterial mapping mandatory
Embolectomy may be not enough

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