vascular diseases: varicose veins, dvt and aneurysms cvs6 dr hisham alkhalidi
TRANSCRIPT
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Vascular diseases:Varicose veins, DVT and Aneurysms
CVS6
Dr Hisham Alkhalidi
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Lecture 6
Diseases of arteries and veins:
• Pathology of varicose veins, thrombophlebitis and deep vein thrombosis.
• Definition of aneurysm, types and aetiology of aneurysms.
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Varicose Veins
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Varicose Veins
• Abnormally dilated, tortuous veins produced by prolonged increase in intraluminal pressure and loss of vessel wall support
• The superficial veins of the lower leg, venous pressures in these sites can be markedly elevated
• 10% to 20% of adult males• 25% to 33% of adult females
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Varicose Veins
• Increased risk:– Obesity – Hereditary– Proximal thrombus – Proximal compression (e.g. tumor)– legs are dependent for long periods – Higher incidence in women (pregnancy)
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Varicose Veins
• Complications– Stasis dermatitis– Delay healing– Stasis, edema, trophic skin– Varicose ulcers
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Stasis dermatitis
Varicose ulcer
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DVT
The deep leg veins account for more than 90% of cases of phlebothrombosis
• Other sites include:– The periprostatic venous plexus in males– The pelvic venous plexus in females– The large veins in the skull and the dural sinuses
(especially in the setting of infection or inflammation)
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DVT
• Predisposing factors:– Congestive heart failure– Neoplasia – Pregnancy– Obesity– Postoperative state– Prolonged bed rest – Genetic hypercoagulability syndromes
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DVT
• Trousseau sign:– In patients with cancer, particularly
adenocarcinomas, hypercoagulability occurs as a paraneoplastic syndrome related to tumor elaboration of procoagulant factors
– In this setting, venous thromboses classically appear in one site, disappear, and then reoccur in other veins, so-called migratory thrombophlebitis (Trousseau sign)
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DVT• 50% clinically silent.• Local manifestations:– Distal edema– Cyanosis– Superficial vein dilation– heat, tenderness, redness, swelling and pain– Sometimes, the first manifestation of thrombophlebitis
is a pulmonary embolus – Depending on the size and number of emboli, the
outcome can range from no symptoms at all to death
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ANEURYSMS
localized abnormal dilation of a blood vessel or the heart
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ANEURYSMS
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ANEURYSMS
• The two most important disorders that predispose to aortic aneurysms are:– atherosclerosis (abdominal aorta)– hypertension (ascending aorta)
• Other causes of aneurysms:• Trauma • Congenital (berry aneurysms in the circle of Willis)• Infections (mycotic aneurysms, syphilis)• Vasculitides
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ANEURYSMS
• Mycotic aneurysm– may originate either from:» embolization and arrest of a septic embolus at
some point within a vessel, usually as a complication of infective endocarditis
» an extension of an adjacent suppurative process
» circulating organisms directly infecting the arterial wall
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ANEURYSMS
• Complications– Rupture– Hemorrhage– Occlusion of proximal vessels– Embolism
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ANEURYSMS
• abdominal aortic aneurysm (AAA):– More in men and rarely develops < 50 years– Abdominal aorta is the main location but the
common iliac arteries, the arch and descending parts of the thoracic aorta can be involved
– Below the renal arteries and above the bifurcation of the aorta
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ANEURYSMS
• abdominal aortic aneurysm (AAA):– Risk of rupture:• 11% per year for aneurysms between 5.0 and 6 cm in
diameter
• Operative mortality for unruptured aneurysms is approximately 5%, whereas emergency surgery after rupture carries a mortality rate of more than 50%
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ANEURYSMS
• SYPHILITIC (LUETIC) ANEURYSMS:– The obliterative endarteritis of the the vasa
vasorum of the thoracic aorta can lead to aneurysmal dilation that can include the aortic annulus
– Ascending aorta and arch– May cause aortic valve ring dilation -> valvular
insufficiency -> ventricular wall hypertrophy, sometimes to 1000 gm "cor bovinum" (cow's heart)
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• SYPHILITIC (LUETIC) ANEURYSMS
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Dissecting hematoma
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• Causes–Hypertension– Connective tissue defects– Cannulation or other trauma– Preganancy
Dissecting hematoma
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Types
Type A is associated with serious complications
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Dissecting hematomaClinical picture
• sudden onset of excruciating pain:– usually beginning in the anterior chest– radiating to the back between the scapulae– moving downward as the dissection progresses
AorticDissection.wmv
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Dissecting hematoma Clinical picture
• cardiac tamponade• aortic insufficiency• myocardial infarction• extension of the dissection into the great
arteries of the neck or into the coronary, renal, mesenteric, or iliac arteries– causing critical vascular obstruction; compression
of spinal arteries may cause transverse myelitis
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