vascular diseases: varicose veins, dvt and aneurysms cvs6 hisham alkhalidi
TRANSCRIPT
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Vascular diseases:Varicose veins, DVT and Aneurysms
CVS6
Hisham Alkhalidi
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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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Phlebothrombosis
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– The postoperative state– Prolonged bed rest – Genetic hypercoagulability syndromes
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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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Types
• Figure
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Causes
• The two most important causes of aortic aneurysms are:– atherosclerosis– cystic medial degeneration of the arterial media
• Other causes of anurysms:• trauma • congenital (berry aneurysms)• infections (mycotic aneurysms, syphilis)• Vasculitides
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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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Complications
• Rupture• Hemorrhage• Occlusion of proximal vessels• Embolism
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AAA
• More in men and rarely develops < 50 years• Abdominal aorta (abdominal aortic aneurysm,
often abbreviated AAA) but the common iliac arteries, the archand descending parts of the thoracic aorta can be involved
• Below the renal arteries and above the bifurcation of the aorta
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Risk of rutpture
• 11% per year for aneurysms between 5.0 and 5.9 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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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.
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SYPHILITIC (LUETIC) ANEURYSMS
• Ascendin 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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Dissecting hematoma
• Figure
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• Figure
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• Figure
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Causes
• Hypertension• Connective tissue defects• Cannulation or other trauma• Preganancy
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Types
• Figure
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Clinical 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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Clinical manifestations
• 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