ARTERIAL OCCLUSION

Dr. Rehan Ahmed Khan FCPS, FRCS, MHPE

Arterial Occlusion
Arterial anatomy Etiology of occlusion Pathophysiology Clinical features Investigations Treatment

Etiology
Diabetes

Smoking
Hypertension Obesity High cholesterol levels Males

Symptoms produced

Lower limb Claudication Rest pain Gangrene

Brain TIA Stroke

Kidney Hypertension Renal failure

Myocardium

Angina Infarction Abdominal pain infarction

Intestine

Features of arterial occlusion in the leg

It is a cramp like pain felt in the muscles that is Brought on walking Not present on taking the first step Relieved by standing still Commonly felt in the calf but it can affect the thigh or buttock

Intermittent claudication

Rest pain

Pain in leg at rest Exaggerated by lying down or elevation of the foot Pain is worse at night

Coldness, numbness,paraesthesia and color change

Affected legs blanch on elevation and develop a purple discoloration on dependency

Ulceration and gangrene

Painful erosion between toes or as a shallow, non healing ulcers on the dorsum of the feet, on the shins, maleolli

Temperature sensation and movement

Foot is usually cold But may equilibrate with the surrounding temperature Acute ischeamic- frequently paralysed and insensate Chronic ischaemia-

Arterial pulsations Arterial bruits Venous refilling

Absent Diminished in case of collaterals Normal with highly develop collateral circulation Phenomenon of disappearing pulse

Bruit indicates turbulence suggesting stenosis

Limb elevated for 30s and then laid flat. Slow refilling indicates arterial insufficiency

Relationship of clinical findings to site of disease

Investigation of arterial occlusive disease

General investigation

Doppler ultrasound blood flow detection

Treadmill

ABPI

Duplex imaging

Arteriography

General investigations
Sugar levels Lipid profile Hb level ECG Echocardiography

ANKLE BRACHIAL PRESSURE INDEX

First, bilateral arm and ankle systolic BP is measured; because ankle pulses may be difficult to palpate, a Doppler probe may be placed over the dorsalis pedis or posterior tibial arteries PAD = ABPI Less than or equal to 0.90 Mild = 0.7-0.9 Moderate = 0.41 0.7 Severe = less than or equal to 0.40

Doppler ultrasound and blood flow detection

Duplex Imaging

Arteriography

Non-surgical managment
General
Walk (spontaneous improvement occurs in many patients over 6 months after the 1st occlusive episode) Exercise Stop smoking Dietary advice Care of the ischemic foot

Drugs
Antidiabetic medications Antihypertesive medications Statins Antiplatelet Newer drugs as cilostazol

Surgical options
Transluminal Angioplasty and stenting By pass operations

OCCLUSION
Aortoiliac

BY PASS OPERATION
Aortofemoral Femorofemoral Ileofemoral crossover axillobifemoral Femoropopliteal femorotibial

Femoral artery Below the popliteal artery

6 month