VASCULAR
SUMMARY OF
INDEX
ACUTE & CHRONIC ISCHEMIA
ANEURYSM
A-V FISTULA
DIABETIC FOOT
BURGER’S DISEASE
THORACIC OUTLET $
DEEP VENOUS THROMBOSIS
CHRONIC VENOUS INSUFF.
VARICOSE VEINS
CHRONIC LEG ULCERS
LYMPHEDEMA if you found it useful
MISCELLANEOUS
kindly share!
, "Sudden ¯ in the artrial bl. supply causing THREAT to limb viability!
Giving no time for collaterals to open"
ETIOLOGY C/P = 6PS COMP.
1) Embolism ® M/C & worst. 1) Pain: earliest & the main presenting 1) MS NECROSIS ® within 6-12 hrs.
· Sudden onset.
2) Acute Thrombotic (On top of As) · Site of obst. & shoots dx. 2) MOIST ASEPTIC GANGRENE ® within 24 hrs.
3) Arterial Injuries. · Bursting or stabbing 3) EXTENSION OF THE THROMBUS.
· by mov. or warmth.
4) Dissecting aortic aneurysm. 4) CHRONIC ISCHEMI IF:
2) Pallor.
5) Phlegmasia. (Massive DVT) a) Acute thrombotic.
3) Progressive coldness.
6) Spasm. (Ergot poisoning) b) Acute embolic at low level occl.
4) Parenthesia & numbness then sensory loss. only (Infra-popliteal)
7) IA injections. (Addicts)
5) Paresis & ms weakness ® Paralysis. 5) AFTER TTT ® Reperfusion $
SIGNS OF IRREVERSIBLE ISCHEMIA If Embolectomy after 6hrs.. = 3C
6) Pulselessness ® loss of dx. pulsations
(INDICATIONS OF AMPUTATION?
• Ms. turgidity or fixed mottling.
• Palpable popliteal pulse ® BKA.
• Not palpable ® AKA. COMPARTMENTAL $ CARDIAC ARRHYTHMIA CRUSH $
PATH. PR. IN A CLOSED FASCIAL COMPARTMENT DT · An. metabolism ® L. Acidosis. Release of Mb from
Release of inflam. mediators ® VD + damage of · K+ from the damaged cells. ischemic ms ®ARF
endoth. ® edema ® pr. in the closed compart.!
TTT. Fasciotomy NaHCO3 & Glucose-insulin inf. Mannitol & Dialysis 1
, ACUTE EMBOLIC ACUTE THROMBOTIC ACUTE ARTERIAL INJURY
ETIO. SOURCE OF EMBOLUS: DISTURBANCE IN VIRCHOW'S TRIAD a) OPEN:
1. heart: · Penetrating traumas.
1) Atherosclerosis. (M/C)
· Following arterial cannulation.
· AF (M/C) – MI. 2) Polycythemia.
b) CLOSED:
· Prosthetic valves. 3) Dehydration.
4) Prolonged immobilization. · Plaster or tourniquet compression.
· SBE.
5) Typhoid fever. · Fracture or dislocation.
2. Aortic Aneurysm.
· Blunt injuries
PATH. SITE OF IMPACTION = BIFURCATION OF VS SITE: LOWER DOWN 1) Complete injury ® Ischemia.
(COMMON FEMORAL, AORTA, POPLITEAL) (ON TOP OF CHR. ISCHEMIA)
2) Partial ® bleeding.
· Small diameter.
· Slow circulation. TYPES OF ARTERIAL INJURIES:
· Turbulence. 1) COMPRESSION ® Reversible ischemia.
· M/C site ® Bifurcation of Common
2) CONTUSION ® VC & spasm or thrombosis.
femoral A.
3) CLEAN CUT: partial = Hge / Complete= ischemia.
4) LACERATED (in crushed injuries ® ischemia.
5) A-V FISTULA ® disturbed hemodynamics & HF.
6) FALSE ANEURYSM ® pulsatile swelling.
CL./P Young age + 6 Ps Age: Old less dt already ischemic LL FIXED (SURE SIGNS) SOFT SIGNS
ONSET Dramatic. (within seconds) Sudden or acute (within hours)
ASSOC. 1) Ext. arterial bleeding 1) Hematoma: small or mod.,
Sudden painless loss of vision! Trophic changes, claudication.
not pulsating nor expanding
H X. AF or recent MI + No hx. of claudication pain Atherosclerosis 2) Persistent ischemia & loss
of pulse after resuscit. 2) Wound px. to a known vs.
EXAM · No trophic changes. · Trophic changes.
3) Expanding hematoma 3) Injury of a nearby n.
· Pulse ® AF or normal on the other · Pulse ® Regular or weak on · Pulsatile swelling.
side. other side 4) Unilat. limb ischemia with
· Palpable thrill. absent pulse.
· Machinery murmur.
2
SUMMARY OF
INDEX
ACUTE & CHRONIC ISCHEMIA
ANEURYSM
A-V FISTULA
DIABETIC FOOT
BURGER’S DISEASE
THORACIC OUTLET $
DEEP VENOUS THROMBOSIS
CHRONIC VENOUS INSUFF.
VARICOSE VEINS
CHRONIC LEG ULCERS
LYMPHEDEMA if you found it useful
MISCELLANEOUS
kindly share!
, "Sudden ¯ in the artrial bl. supply causing THREAT to limb viability!
Giving no time for collaterals to open"
ETIOLOGY C/P = 6PS COMP.
1) Embolism ® M/C & worst. 1) Pain: earliest & the main presenting 1) MS NECROSIS ® within 6-12 hrs.
· Sudden onset.
2) Acute Thrombotic (On top of As) · Site of obst. & shoots dx. 2) MOIST ASEPTIC GANGRENE ® within 24 hrs.
3) Arterial Injuries. · Bursting or stabbing 3) EXTENSION OF THE THROMBUS.
· by mov. or warmth.
4) Dissecting aortic aneurysm. 4) CHRONIC ISCHEMI IF:
2) Pallor.
5) Phlegmasia. (Massive DVT) a) Acute thrombotic.
3) Progressive coldness.
6) Spasm. (Ergot poisoning) b) Acute embolic at low level occl.
4) Parenthesia & numbness then sensory loss. only (Infra-popliteal)
7) IA injections. (Addicts)
5) Paresis & ms weakness ® Paralysis. 5) AFTER TTT ® Reperfusion $
SIGNS OF IRREVERSIBLE ISCHEMIA If Embolectomy after 6hrs.. = 3C
6) Pulselessness ® loss of dx. pulsations
(INDICATIONS OF AMPUTATION?
• Ms. turgidity or fixed mottling.
• Palpable popliteal pulse ® BKA.
• Not palpable ® AKA. COMPARTMENTAL $ CARDIAC ARRHYTHMIA CRUSH $
PATH. PR. IN A CLOSED FASCIAL COMPARTMENT DT · An. metabolism ® L. Acidosis. Release of Mb from
Release of inflam. mediators ® VD + damage of · K+ from the damaged cells. ischemic ms ®ARF
endoth. ® edema ® pr. in the closed compart.!
TTT. Fasciotomy NaHCO3 & Glucose-insulin inf. Mannitol & Dialysis 1
, ACUTE EMBOLIC ACUTE THROMBOTIC ACUTE ARTERIAL INJURY
ETIO. SOURCE OF EMBOLUS: DISTURBANCE IN VIRCHOW'S TRIAD a) OPEN:
1. heart: · Penetrating traumas.
1) Atherosclerosis. (M/C)
· Following arterial cannulation.
· AF (M/C) – MI. 2) Polycythemia.
b) CLOSED:
· Prosthetic valves. 3) Dehydration.
4) Prolonged immobilization. · Plaster or tourniquet compression.
· SBE.
5) Typhoid fever. · Fracture or dislocation.
2. Aortic Aneurysm.
· Blunt injuries
PATH. SITE OF IMPACTION = BIFURCATION OF VS SITE: LOWER DOWN 1) Complete injury ® Ischemia.
(COMMON FEMORAL, AORTA, POPLITEAL) (ON TOP OF CHR. ISCHEMIA)
2) Partial ® bleeding.
· Small diameter.
· Slow circulation. TYPES OF ARTERIAL INJURIES:
· Turbulence. 1) COMPRESSION ® Reversible ischemia.
· M/C site ® Bifurcation of Common
2) CONTUSION ® VC & spasm or thrombosis.
femoral A.
3) CLEAN CUT: partial = Hge / Complete= ischemia.
4) LACERATED (in crushed injuries ® ischemia.
5) A-V FISTULA ® disturbed hemodynamics & HF.
6) FALSE ANEURYSM ® pulsatile swelling.
CL./P Young age + 6 Ps Age: Old less dt already ischemic LL FIXED (SURE SIGNS) SOFT SIGNS
ONSET Dramatic. (within seconds) Sudden or acute (within hours)
ASSOC. 1) Ext. arterial bleeding 1) Hematoma: small or mod.,
Sudden painless loss of vision! Trophic changes, claudication.
not pulsating nor expanding
H X. AF or recent MI + No hx. of claudication pain Atherosclerosis 2) Persistent ischemia & loss
of pulse after resuscit. 2) Wound px. to a known vs.
EXAM · No trophic changes. · Trophic changes.
3) Expanding hematoma 3) Injury of a nearby n.
· Pulse ® AF or normal on the other · Pulse ® Regular or weak on · Pulsatile swelling.
side. other side 4) Unilat. limb ischemia with
· Palpable thrill. absent pulse.
· Machinery murmur.
2
