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Duplex Vascular
Doppler Vascular
Phletysmography
Laser Doppler Fluximetry and Dynamic Videomicroscopy
MRA / MSCT A
Angiography
Modality of Intervention
Angiography
Aspiration tool
IVUS
Laser
Hyperbaric ???
Surgery
In The Lower Limb
Acut Limb Ischemia ( ALI )
Chronic Limb Ischemia :
- Intermittent Claudicatio ( I C )
- Critical Limb Ischemia (C L I )
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Causes:
• Atherosclerosis
• Burger’s disease
• Raynaud’s disease
• Others
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Atherosclerosis
Definition:
It is the process underlying the formation of
focal obstructions or plaques in large &
medium sized arteries. It is characterised by
the presence of focal intimal thickening, these
intimal elevations being made up of
accumulations of cholesterol rich & a
proliferation of connective tissue. An essential
component of atherogenesis is inflammation
involving monocytes / macrophages, T
lymphocytes & mast cells.
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Risk factors
• Smoking
• Hypertension
• Hyperlipidaemia (raised LDL) High risk factors
• High fat diets
• Diabetes mellitus
• Elevated blood uric acid (gout)
• Hypothyroidism
• Renal disease Other risk factors
• Familial history of premature atherosclerosis
• Male sex & age
• Sedentary life
• Obesity Factors having an uncertain role
• Anxiety
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Symptoms
• Intermittent claudication
• Rest pain
• Erectile dysfunction
• Sensorimotor impairment
• Tissue loss
Signs
• Muscular atrophy
• Decrease hair growth
• Thick toenails
• Tissue necrosis ulcers infection
• Absent pulses
• Bruits
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Lower limb ischemia
• Intermittent claudication:
• ABI: 0.5-0.9
• Cludication distance
• Calf is the most common
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Rest pain
• Worst at night,lying, relieved by putting the
leg in dependent site
• Coldness
• Numbness
• Parasthesia
• Color change
• Differentiated from night cramps
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Ulcers and gangrene
• Gangrene Between the toes
• Ulcers at the foot dorsum and leg shins
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investigation
• General
• Diabetes
• Lipid profile
• Anemia
• High viscosity
• Full blood count
• Plasma fibrinogen
• Blood and urine glocuse
• ECG
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Investigation (non-invasive.)
• Doppler ultrasound
• ABI( rest and exercise )
• Duplex imaging:
• Blood flow and turbulence
• Plethysmography
• treadmill
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Investigation( invasive)
• Arteriography
• To decide whether intervention is needed
• Seldinger technique
• Hazards:
• Thrombosis
• Dissection
• Heamatoma
• Neurological dysfunction
• Anaphylaxis
• Digital substraction angiography
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Management
• Explanation and advice
• Life style adjustment
• Smoking
• Exercise
• Diet
• Heal raise
• Analgesics and use of position
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• Sympathectomy
• Transluminal angioplasty: usually
percutaneous
• Iliac success more than the leg arteries
• bypass
• Atherectomy
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Intermittent Claudicatio
Clinical Diagnosis Suspected
Pain induced by activity and reduced by rest
Skin tropic lesion
Confirmation Diagnosis
Ankle Pressure <50 mmHg by Doppler ( non DM )
Toe Pressure <40 mmHg by Photo Phletysmography ( DM )
Type of lesion by Arteriography
Conservative Treatment of CRITICAL LIMB ISCHEMIA