arterial disaeses pptx - د. زياد طارق

Deep Vein Thrombosis

Low risk: young, with minor illnesses, who are to undergo operations lasting 30 min or less.

Moderate risk: over 40 or with a debilitating illness who are to undergo major surgery.

High risk: over 40 who have serious medical conditions, or undergoing major surgery with an additional risk factor.
Prophylaxis:

Risk factors:

Patients factors:
• Age
• Obesity
• Varicose veins
• Immobility
• Pregnancy
• Puerperium
• Oral contraceptive pills
• Previous deep vein thrombosis or pulmonary embolism

• Trauma or surgery,
• Malignancy,
• Heart failure
• Recent myocardial infarction
• Paralysis of lower limb(s)
• Infection
• Inflammatory bowel disease
• Nephrotic syndrome
• Polycythaemia
• Paraproteinaemia

Mechanical methods:

• graduated elastic compression stockings
• external pneumatic compression
• passive foot movement (foot paddling machine)
• simple limb elevation
Pharmaceutical methods:
• low molecular weight heparin
• unfractionated heparin
• warfarin

Methods of prophylaxis:

Graduated elastic compressive stocking

External pneumatic compression

Foot Paddling Machine

Venous thrombectomy:

Phlegmasia cerulea dolens with contraindication to thrombolytics

Inferior vena cava filter:

Recurrent thromboembolism despite adequate anticoagulation
Progressing thromboembolism despite adequate anticoagulation
Complication of anticoagulants
Contraindication to anticoagulants

Surgical treatment:

Venous thrombectomy

IVC filter:

Lymphatic Disorders

Acute Lymphangitis:
Infection caused by Streptococcus pyogenes or Staphylococcus aureus that spreads to the draining lymphatic vessels and lymph nodes (lymphadenitis)

Treatment:

Rest and elevation
i.v. antibiotics

Related to lymphoedema

Lymphedema:

Edema due to high protein ISF secondary to defective lymphatic drainage in the presence of normal capillary filtration

Pathophysiology:

Edema  high capillary filtration  normal but overwhelmed venous and lymphatic system  protein low edema

Lymphedema  normal capillaries  defective lymphatics  protein rich edema

Sometimes  high capillary filtration + defective lymphatics  both types of edema

Lymphedema is confined to the epifascial space

Classification:
Primary lymphoedema, :
Congenital lymphoedema (Millroy's disease)
Lymphoedema praecox (Meige's disease)
Lymphoedema tarda
Secondary or acquired lymphoedema,
Infection (fungal, parasitic, bacterial ..etc.)
Exposure to foreign body material (silica particles)
Malignancy (primary or metastatic)
Trauma (surgery, radiotherapy, penetrating injury,…etc.)
Venous disorders (DVT, thrombophlebitis, …etc.)

Clinical presentation:
Lymphoedema characteristically involves the foot
May spread to knee, rarely to the thigh
Early it is pitting, later on it becomes non-pitting
Skin problems (fungal, viral or bacterial infection)
Ulceration is unusual
Lymphangiomas
lymphangiosarcoma

Investigations:

• MRI
• Lymphangiography
• Duplex ultrasound

Treatment:

• Pain relief
• Skin care
• Control of swelling (decongestive lymphatic edema therapy)
• Manual lymphatic drainage (MLD)
• Multilayer lymphedema bandaging (MLLB)
• Exercise
• Drugs
• Surgery (lymphatic bypass procedures or limb reduction procedures)

MLD