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7/29/2019 Arterial Occlusion 3rd Year
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ARTERIAL OCCLUSIONDr. Rehan Ahmed KhanFCPS, FRCS, MHPE
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Arterial Occlusion
Arterial anatomy
Etiology of occlusion
Pathophysiology
Clinical features
Investigations
Treatment
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Etiology
Diabetes
Smoking
Hypertension
Obesity
High cholesterol levels
Males
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Symptoms produced
Lower limb
Claudication
Rest pain
Gangrene
Brain
TIA
Stroke
Kidney
Hypertension
Renal failure
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Angina
Infarction
Myocardium
Abdominal paininfarction
Intestine
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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
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Pain in leg at rest
Exaggerated by lying
down or elevation of
the foot
Pain is worse at night
Rest
pain
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Affected legs blanch on
elevation and develop a
purple discoloration on
dependency
Coldness,
numbness,paraesthesia
and color change
Painful erosion between toes
or as a shallow, non healing
ulcers on the dorsum of the
feet, on the shins, maleolli
Ulceration and
gangrene
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Foot is usually cold
But may equilibrate withthe surrounding
temperature
Acute ischeamic- frequently
paralysed and insensate Chronic ischaemia-
Temperaturesensation
and
movement
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Absent
Diminished in case of collaterals
Normal with highly develop collateral circulation
Phenomenon of disappearing pulse
Arterial
pulsations
Bruit indicates turbulence suggesting stenosisArterial
bruits
Limb elevated for 30s and then laid flat.
Slow refilling indicates arterial insufficiency
Venous
refilling
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Relationship of clinical findings to
site of disease
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Investigation of arterial occlusive
disease
Generalinvestigation
ABPI
Doppler
ultrasound
blood flowdetection
Duplex
imaging
Treadmill
Arteriography
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General investigations
Sugar levels
Lipid profile
Hb level
ECG
Echocardiography
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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
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Doppler ultrasound and blood flow
detection
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Duplex Imaging
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Arteriography
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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
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Surgical options
Transluminal Angioplasty and stenting
By pass operations
OCCLUSION BY PASS OPERATIONAortoiliac Aortofemoral
Femorofemoral
Ileofemoral crossover
axillobifemoral
Femoral artery Femoropopliteal
Below the popliteal artery femorotibial
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6 month
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