basic principles of vascular surgery anatomy physiology pathology pathophysiology clinical...
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Basic principles of vascular surgery Anatomy Physiology Pathology Pathophysiology Clinical presentation.History, physical
exam. investigationmanagement
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physiology Haemostasis vasoconstriction platelet
aggregation Coagulation intrinsic, extrinsic Fibrinolysis Renin angiotensin system
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Vascular pathology Atherosclerosis: placque formation,flow
effect, fate of the placque Risk factors Clinical sequelae : stenosis, occlusion,
thrombosis, embolisation, aneurysm
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Vascular pathology1-Trauma:RTA,falls, stabs, gun shot, sharps
Iatrogenic DRUG ADDICT2-Inflammatory: (VASCULITIS)
Takayassaue, Kawasaki, Beurger Connective tissue (SLE, polyart. Nod., Rh.
Art.,)3-Spasmodic Reynauds dis.,
phenomenon4-Conginetal malformation : venous,
arterial AVM
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symptomatology
Chief complaint, history of the present illness
Peripheral vascular symptoms
atherosclerosis risk factors
Review of important systems
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Peripheral vascular symptoms Acute ischaemia Chronic ischaemia Infection Neuropathy Foot trauma/injury Syndromes amaurosis fugax,
dysphagia lusoria, Leriche , TIA, CVA
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Atherosclerosis risk factors Nonmodifiable age , gender , family
Modifiable D.M., Hypertension, Smoking
Dyslipidaemia, obesity, stress
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Review of systems Cardiac
Cerebral
Renal
Gastrointestinal
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Renovascular hypertension 10-20%of secondary hypertension Uncontrolled despite 2-3 meds Flash pul.oedema Hypokalaemia Captopril test Doppler US., MRA Angioplasty
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Examination
Pulse, B.P., Edema Local inspection Colour elevation,
dependency Skin trophic changes Driness, hair, nails,
wasting venous filling Ulcers , Gangrene
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Ulcers def., typesGangreneinfarction Necrosis
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Examination Palpation temp. pulses, cap. Filling
Auscultation carotid , femoral
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Investigation Bood work, ECG, CXR Non invasive vascular lab ankle/brachial index exercise test , toe pressure doppler ultrasoundInvasive angiography, CT, MRA
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Medical Management
1-Risk factors control
2-improve blood flow aspirin, pentoxyphylline clopidogrel, anticoagul.
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Aspirin mechanism of actionPhosphlipids---arachidonic acid----(cyclo-
oxygena)--endoperoxides:In plt. --------thromboxane(throm.synth) ATP-----ADP(plt aggreg.+vasocons)In blood vessel endoth.Endoperox.----prostacyclin(stimulate adenyl
cyclase) ATP------cAMP(plt sgreg.+vasodil) -----5AMP
(phosphodiesterase)
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Surgical management For rest pain, ulcers, gangrene Embolectomy , thrombectomy, Vascular reconstructionEndart.,repair,
resection+interposition,BypassUsing saphenous vein (reverse/insitu)or
PTFE Amputation toe, transmet., symes,BK,AK