vascular diseases and surgery khaled daradka faculty of medicine / university of jordan general...
TRANSCRIPT
![Page 1: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/1.jpg)
VASCULAR DISEASES
AND SURGERY
VASCULAR DISEASES
AND SURGERY
Khaled Daradka
Faculty of Medicine / University of Jordan
General Surgery Department
1
![Page 2: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/2.jpg)
Peripheral Arterial Disease Peripheral Arterial Disease
Definition:• Also known as PVD.
• Occlusive disease of the arteries of the lower extremity.
• Most common cause:o Atherothrombosiso Others: arteritis,
aneurysm + embolism.
• Has both ACUTE and CHRONIC Px
![Page 3: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/3.jpg)
PAD PAD
Pathophysiology:• Arterial narrowing
Decreased blood flow = Pain
• Pain results from an imbalance between supply and demand of blood flow that fails to satisfy ongoing metabolic requirements.
![Page 4: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/4.jpg)
4
Introduction
Atherosclerotic changes
Introduction
Atherosclerotic changes
Normal Artery Diseased Artery
![Page 5: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/5.jpg)
5
Introduction
Disease evolution
Introduction
Disease evolution• Claudication
• Rest pain
• Ulceration
• Gangrene
• Limb loss
![Page 6: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/6.jpg)
6
Risk FactorsRisk Factors
• Tobacco abuse
• Diabetes
• Hypercholesterolemia
• Hypertension
• Obesity
• Sedentary lifestyle
![Page 7: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/7.jpg)
7
DiagnosisDiagnosis
• Patient history
• Physical examination
• Laboratory values
• Noninvasive vascular studies
• Angiography
![Page 8: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/8.jpg)
8
Patient HistoryPatient History
• Risk factors
• Exercise-induced symptoms
• Rest pain
• Ulceration
![Page 9: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/9.jpg)
9
Patient HistoryPatient History
Historical clues to the diagnosis of intermittent claudication
Variable Symptom ComplexSymptoms in the legs that are provoked
by walking and relieved by rest
Pain Aches Tiredness
Tightness Soreness Weakness Numbness
![Page 10: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/10.jpg)
10
Is it vascular limb pain?Is it vascular limb pain?
Patient HistoryPatient History
Historical Vascular NeurogenicClue Etiology Etiology
Onset Predictable Variable
Only withwalking? Yes No
Relief with stopping or Yes Variablestanding?
Absent pedal Variable Variablepulses at rest
![Page 11: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/11.jpg)
11
Patient History
Differential diagnosis of PAD
Patient History
Differential diagnosis of PAD• Intermittent claudication
– Atherosclerosis– Non-atherosclerotic
Buerger’s Vasculitis
• Neurogenic causes– Lumbar canal stenosis– Peripheral neuropathy
• Venous claudication
• Musculoskeletal causes– Arthritis– Bursitis– Tendonitis
• Pediatric causes– Plantar fasciitis
![Page 12: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/12.jpg)
12
Physical ExaminationPhysical Examination
• Pulses
• Bruits
• Ankle-Brachial Index (ABI)
![Page 13: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/13.jpg)
13
Physical Examination
Ankle-Brachial Index
Physical Examination
Ankle-Brachial Index• Simple, painless, accurate, highly
reproducible examination
• Clinically useful– Identifies patients with PAD
– Major indicator of premature MI, CVA, mortality
• Indications– Any patient with suspicion for PAD
– Any patient at risk of PAD Age 50 or greater with history of DM or tobacco use Age 70 or greater regardless of risk factors
![Page 14: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/14.jpg)
14
Right ArmPressure:
Left ArmPressure:
Pressure:
PT
DP
Pressure:
PT
DP
Physical Examination
Ankle-Brachial Index
Physical Examination
Ankle-Brachial Index• How to perform
– Patient resting supine for 5-10 minutes
– Continuous wave, hand-held Doppler
– Measure systolic BP in both arms
Higher value is DENOMINATOR of ABI
– Measure systolic BP in DP and PT
Higher value is NUMERATOR of ABI
![Page 15: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/15.jpg)
15
Physical ExaminationPhysical Examination
ABI = Ankle Systolic Pressure
Brachial Systolic Pressure
>0.9 = Normal
>0.4-0.9 = Moderate disease
<0.4 = Severe disease
![Page 16: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/16.jpg)
16
Above 0.90 — Normal
0.71-0.90 — Mild Obstruction
0.41-0.70 — Moderate Obstruction
0.00-0.40 — Severe Obstruction
Physical Examination
Interpretation and limitations of ABI
Physical Examination
Interpretation and limitations of ABI
ABI Interpretation Two Main Limitations
Calcified ankle vessels result in artificially “normal” ABI (DM, RF)
Normal ABI in patient with Aortoiliac Disease— only becomes abnormalwith exercise testing
![Page 17: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/17.jpg)
17
Noninvasive Vascular StudiesNoninvasive Vascular Studies
• Vascular ultrasound
• CT angiography
• Magnetic resonance angiography
![Page 18: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/18.jpg)
18
Noninvasive Vascular Studies
Post-intervention iliac imaging
Noninvasive Vascular Studies
Post-intervention iliac imaging
![Page 19: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/19.jpg)
19
Noninvasive Vascular Studies
MRA in PAD
Noninvasive Vascular Studies
MRA in PAD
![Page 20: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/20.jpg)
20
RightFem-Pop
BPG
DSA(Pre-PTA)
LeftSFA
Stenosis
Noninvasive Vascular StudiesNoninvasive Vascular Studies
CTA
![Page 21: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/21.jpg)
21
Normal Abnormal
Invasive Vascular Studies
Diagnosis−angiography
Invasive Vascular Studies
Diagnosis−angiography
![Page 22: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/22.jpg)
22
TreatmentTreatment
• Risk factor modification
• Medical management
• Minimally invasive techniques
• Surgical intervention
![Page 23: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/23.jpg)
23
GoalsGoals
Identify and treat systemic
atherosclerosis
Improve functional status and quality
of life
Preserve the limb
Prevent progression ofatherosclerosis
PAD Therapeutic Goals
![Page 24: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/24.jpg)
24
Risk Factor ModificationRisk Factor Modification
• Tobacco cessation
• Exercise
• Weight reduction
• Pharmacologic intervention– Hypercholesterolemia
– Hypertension
– Diabetes
![Page 25: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/25.jpg)
25
Minimally Invasive Techniques Minimally Invasive Techniques
• Percutaneous transluminal angioplasty (PTA)
• Stenting
• Thrombolysis
![Page 26: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/26.jpg)
26
Minimally Invasive Techniques Minimally Invasive Techniques
Guidewire placement
![Page 27: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/27.jpg)
27
Minimally Invasive Techniques Minimally Invasive Techniques
Guidewire advanced past lesion
![Page 28: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/28.jpg)
28
Balloon dilatation
Percutaneous Transluminal Angioplasty
Minimally Invasive Techniques Minimally Invasive Techniques
![Page 29: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/29.jpg)
29
Minimally Invasive Techniques Minimally Invasive Techniques
Stent expansion by a balloon catheter over a guidewire
![Page 30: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/30.jpg)
30
Post-PTA/stent placement
Minimally Invasive Techniques Minimally Invasive Techniques
![Page 31: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/31.jpg)
31
Thrombolysis
Post-thrombolytic infusion revealing stenosis
Minimally Invasive Techniques Minimally Invasive Techniques
![Page 32: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/32.jpg)
32
Case Study #1Case Study #1
Aorto/iliac disease
![Page 33: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/33.jpg)
33
Case Study #1Case Study #1
Aorto/iliac diseasepre-PTA stenting
Aorto/iliac diseasepost-PTA stenting
![Page 34: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/34.jpg)
34
Case Study #2Case Study #2
Pre-thrombolysis Post-thrombolysis
![Page 35: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/35.jpg)
35
Case Study #2Case Study #2
Angioplasty post-thrombolysis
![Page 36: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/36.jpg)
36
Surgical InterventionSurgical Intervention
• Bypass grafts
• Amputation
![Page 37: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/37.jpg)
37
Surgical InterventionSurgical Intervention
• Bypass grafts
![Page 38: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/38.jpg)
What are the features of an
acute ischemic limb?
What are the features of an
acute ischemic limb?REMEMBER THE 6 P’S:
1.PAIN
1.PALLOR
1.PULSELESNESS
1.PERISHING COLD (POIKILOTHERMIA)
1.PARASTHESIAS
1.PARALYSIS
![Page 39: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/39.jpg)
Venous Disease (CVI) Venous Disease (CVI)
Simple spider veins to complex dermal sclerosis and ulcer
formations.
39
![Page 40: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/40.jpg)
Venous Valves Venous ValvesPresence of
valves prevent reflux
Pressure generated in deep veins by the calf muscles are prevented from transmission to superficial veins by the valves
40
![Page 41: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/41.jpg)
Venous Pathology Venous Pathology
Obstruction
Reflux and/or incompetence
41
![Page 42: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/42.jpg)
Venous Obstruction Venous Obstruction
As a result of DVT or superficial phlebitis
As a result of extrinsic compression
42
![Page 43: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/43.jpg)
Venous Reflux Venous Reflux
Spider Veins Varicose Veins
43
![Page 44: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/44.jpg)
Venous Reflux Venous Reflux
Edema Venous Statis w/wo Ulcer
44
![Page 45: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/45.jpg)
Venous History of Patient Venous History of Patient
Pain
Edema
Ulcers
45
![Page 46: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/46.jpg)
Physical Exam of Patient Physical Exam of PatientSupine and Standing
Objective findings of spider or varicose veins
Skin changes (hyperpigmentation to atrophic blanch)
Edema (typically pitting)
Ulcer formation
46
![Page 47: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/47.jpg)
Diagnostic Testing
Duplex Scan
Diagnostic Testing
Duplex Scan
47
![Page 48: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/48.jpg)
Treatment Treatment
Medical Management
1. Leg elevation
2. Compression therapy
3. Exercise
48
![Page 49: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/49.jpg)
Interventional TherapyInterventional Therapy
Sclerotherapy
Endovenous Ablation
Surgical
49
![Page 50: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/50.jpg)
SclerotherapySclerotherapy
50
![Page 51: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/51.jpg)
Similarities and Differences Similarities and Differences
Arterial symptoms produced by exercise and relieved by resting
Venous symptoms worsened by standing and improved by exercise and leg elevation
51
![Page 52: VASCULAR DISEASES AND SURGERY Khaled Daradka Faculty of Medicine / University of Jordan General Surgery Department 1](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649e0e5503460f94af8f00/html5/thumbnails/52.jpg)
THANK YOU
52