Professional Documents
Culture Documents
Patient
dr Putra Hendra SpPD
Uniba
Topic
Artery
- Limb Ischaemia
- Aneurysm
Venous
Leg ulcer
- Varicose vein
Limb Ischaemia
Aetiology: most often atherosclerosis , trauma
Most management decisions are based upon
1.Differentiation
acute vs chronic
Acute ischaemia
Periode of onset in minutes or hours
Sudden catastrophic
Less effect in upper extremity
Acute ischaemia
Symptom
5P
pain
pulselessness
paresthesia
pallor
paralysis
Marble white
right foot in
acute limb isch
aemia
2. Mechanism of occlusion
Acute iscahemia caused by
Trauma
Non trauma
- embolus
- thrombosis
Trauma-fracture tibia
Embolus
Mobile solid mass
Free floating in blood
Capable of occluding a vein or artery distal
Composition of embolus
Atheromatous debris or thrombus(clot)
(common)
Thrombosis
Rupture of an atheromatous plaque esp
vessel wall
ischaemia = thrombosis
Chronic ischaemia
Symptom
or years
Slow deterioration of function
Gradually symptom
Life style changes-stop smoking or
exercise: remission collateral vv
Chronic ischaemia
Progressive narrowing
Cause : Atheromatous disease is the common cause
Other uncommon cause: Aneurysm:
popliteal aneurysm: special nature
Diabetes
Some rare disease
Buergers disease
Hyperhomocysteineaemia
Takayasus disease
Chronic ischaemia
Symptom
and sign
Claudication
rest pain
ulceration/gangrene
3. Location-aorto-iliac disease
Chronic: claudication at
buttock, thigh calf, loss of
femoral pulse
in men: Leriche syndrome
(French surgeon who
described distal aortic
occlusion and erectile
impotence)
Distal aorta
occlusion
Excess weight
Walking uphill
Walking against wind
Carry shopping
Rest pain first felt in the distal parts such as toes and
dorsum of the foot awake patient need rise from bed
and walking around to relieve
Hanging foot
0.5-0.9 claudication
< 0.5 critial limb ischaemia
< 0.3 gangrene
Treadmill testing
Walking incline 10%
at speed 3 km/hr
Test of function to
allow monitoring
disease and the
result of therapeutic
effort
Ultrasound-duplex scan
Composed of
occlusive lesion
Doppler signal: flow indicate stenosis
Contrast arteriography
Magnetic resonance
arteriography(MRA)
without contrast or
IV gadolinium
Suitable in patient
Aneurysm
Pulsatile expansile mass
Clinical feature:
invade surrounding tissue cause- pain
rupture
embolisation - ischaemia e.g. claudication,
trash foot
Ruptured AAA
Venous disease
Functional anatomy
1.
Normal: superficial to
deep and from
distal(foot) to
proximal(thigh and
heart )
?? At standing position,
blood at ankle has to
return against gravity to
heart over a distance of
> 1 metre how
How
4 factors support this system
Aetiology
Primary e.g. saphenofemorla valve incompetence
Aetiology
Secondary mostly due to previous DVT
Simple obstruction
Destroying the valves within deep vein
Cosmetic presentation
Discomfort and pain
Cramps
Swelling
Complication
- thrombophebitis
- haemorrhage
- CVI
Examination:
standing position
Area of VV
Brodie Tredelenberg test
Perthes test
Continous wave Doppler
VV
previous DVT
Duplex scan
Ascending venography (inject radioopaque in foot and
watching it rise in the deep vein)
Varicose
eczema
Neuropathic ulcer
Venous ulcer
Arterial ulcer
Localised to skin
soft tissue, vein
-cellulitis
-lymphagitis
-thrombophlebitis
5P
+ac emboli
- ac thrombosis
DVT,
rupture of bakers cyst
claudication
Critical limb ischaemia
Rest pain, gangrene, ulcer
Varicose vein
History of swelling, DVT
Confirm with duplex scan
Primary VV
Intervention
Sx, sclerotherapy
Secondary VV
Supportive treatment
edge
base
Ulcer
Punch out
Black, dry
Deep to tendon
Ischaemic ulcer
Sensory ulcer
Above media
malleolus
Asso DVI
Venous ulcer