MANIFESTATIONS OF MANIFESTATIONS OF VASCULAR DISEASESVASCULAR DISEASESMANIFESTATIONS OF MANIFESTATIONS OF VASCULAR DISEASESVASCULAR DISEASES

Prof. Hasan Ali Al Zahrani, FRCSProf. Hasan Ali Al Zahrani, FRCS

Professor of Surgery,Professor of Surgery,

Consultant Vascular SurgeonConsultant Vascular Surgeon

King Abdulaziz University, JeddahKing Abdulaziz University, Jeddah(www.profzahrani.com)(www.profzahrani.com)

Arterial Problems1. Aneurysms : - AAA - peripheral2. Limb ischaemia : - acute - chronic3. Vasculitis : - Types - Thromboangitis obliterans4. Carotid artery disease :5. D.M. foot :

Venous Problems

6. Varicose veins

7. D.V.T. & postphlebitic limb

8. Leg ulcers

Others

9. Vascular malformations

10. Angioaccess

11. Thoracic Outlet Syndrome

12. Vascular Trauma

Aneurysms

Definition :Localized dilatation of an artery

or vein• The commonest is AAA• Rare in veins• Usually due to ATO

Symptoms :

• Most are asymptomatic• Intermittent claudication

(if there is occlusive disease)• Trash foot or blue toes syndrome

(if embolizing)• Severe abdominal and/or back pain

(if leaking)• Shock (if ruptures)

Signs :

• Pulsating epigastric mass – AAA• Pulsating iliac mass - ? Iliac• Examine other arteries 5-10%

associated aneurysms• Abd. tenderness• Shock

Acute Limb Ischaemia

• Sudden cessation of blood flow to lower or less frequently upper limb which is usually due to embolism or trauma and less frequently due to thrombosis.

A.L.I.Causes :1. Embolism : a. Cardiac : very common - A.F. - M.I. in I.H.D. - Rh. H. D - Others b. Non-cardiac : - atheromatous plaques - aneurysm - trauma

A.L.I.

2. Thrombosis : a. Acute or chronic (? I.C.) b. Aneurysms c. Severe D.V.T. (P.C.D.)

A.L.I.

Symptoms & Signs :

• The 5 P’s• Coldness• Poor capillary refilling• Rigor (late signs)• Examine other pulses• Heart examination

A.L.I.

Investigation :

• C.W. Doppler• Duplex scan• Arteriography (in selected cases)• ECG, CXR, Echo

A.L.I.

Management :

• Aim to minimize the time lag to less than 8 hours

• Establish the underlying cause • Heparin infusion• Surgical embolectomy• Fibrinolytic therapy• ? Primary amputation

Chronic Limb Ischaemia (C.L.I.)

• Affects usually the lower limbs• Usually due to atherosclerosis• Common in D.M. patients• Symptoms and signs depend on the

site of occlusion.

Chronic Limb Ischaemia (C.L.I.)

Symptoms :

• Intermittent claudication :- cramping pain affecting usually the calf

muscles which comes with exercise and relieved by rest. (? Distance, radiation)

• Rest pain:- severe burning pain affecting the forefoot,

coming at rest and relieved by hanging the leg beside the bed

• Impotence :- Leriche’s Syndrome

Chronic Limb Ischaemia (C.L.I.)

Signs :

• Ulceration :- painful, no bleeding• Pallor, Buerger’s test, rubor or

dependency, capillary re-perfusion• Cyanosis, coldness, trophic changes• Examination of pulses• Listen for bruits

(C.L.I.)

Investigations :

• General including :- R.B.S., lipids, CXR, ECG

• Specific:-– A/B index, toe pressure– Duplex scan– MRA, C.T. angio,.– Angiogram

(C.L.I.)

Indications for surgery :

• Disabling I.C.• Critical ischaemia:- I.R.P., ulcer• Impotence• ? Progressive disease

(C.L.I.)

Medical:- Anti-plateletsControl D.M., hyperlip., high B.P.Stop smokingReduce weight and diet? Pentoxyfylline

Endovascular and surgical :- P.T.A. stentingbypassendartrectomyamputation

Vasculitis

Definition : A group of vascular

inflammatorydisorders sharing immune-mediatedreactions but with distinctive clinicalpicture, e.g.• Thromboangitis obliterans• P.A.N., G.C.A., …etc.

Buerger’s Disease (T.A.O.) : -

Vasculitis of small and medium-sizedveins and arteries affecting mainly

youngand middle-aged males who smoke heavily.

Its aetiology in unknown.

Buerger’s Disease (cont) : -

Management :• Diagnosis (including diff. Diag.)• Stop smoking• Vasodilators• Sympathectomy• Bypass• Amputation

Carotid Artery Disease (CAD)

Symptoms :• TIA• PRIND• Amurosis fugax• Stroke• Blindness

Signs :• Carotid bruit• Neurological deficits

C A D

Diagnosis :• Duplex scan• MRA• CT• Carotid angio

C A D

Management :1. Medical : - Antiplatelets

- Anticoagulants- Control risk factors

2. Carotid Endartrectomy3. ?? Angioplasty

D M F

• High incidence of D.M. in S.A.

• The most common indication for amputation

• Factors :– Ischaemia : 40%

– Neuropathy : 60%

– Infection : 90%

D M F

Diagnosis :-• For Infection :-

- CBC, culture, x-ray of foot

• For Ischaemia :-

- Toe pressure, Duplex scan, Angio

• For Neuropathy:-

- EMG

D M FPrevention :-Management : -1. Medical :

- control of D.M. & hyperlipidaemia- antibiotics- Antiplatelets

2. Surgical :- Debridement + drainage- Vascular reconstructive procedure

- Skin grafting- Amputation

TThhaannk k YYoouu !!! !!!TThhaannk k YYoouu !!! !!!