ISCHAEMIC VASCULAR DISORDER
DR GARGADI,S.I
PLASTIC AND RECONSTRUCTIVE SURGEON (FWACS,FICS)
� ������ INTRODUCTION ��A common condition which affects mostly the peripheral limbs in individuals with risks such as cigarette smoking, alcohol intake, vascular diseases and diabetes mellitus. �
������� DEFINITION ���A condition which is caused by impaired blood supply to the tissues that is enough to cause lack of oxygen and nutrient to the tissues for vital function. �
AETIOLOGY �
1. PRESSURE FROM WITHOUT: Such as iatrogenic ligation of the main artery, tight tourniquet, bandage, and p.o.p.
2. OCCLUSION FROM WITHIN: The lumen may be obstructed by embolism 80 percent, thrombosis 20 percent, atherosclerosis or Buerger’s disease (Thrombo-angitis obliterans)
Aneurysm
3. VASCULAR DISORDERS: Vasoconstriction of the wall as in Raynaud’s disease, traumatic arterial spasm and ergot poisoning.
�
PATHOLOGY�
Following arterial injury, occlusion from within (thrombo-embolism) or from without (iatrogenic ligation of artery or pressure from tumor), there is sudden disruption of blood supply which will lead to acute ischemia, with complete impairment of oxygenation and nutrient of the limbs supplied leading to tissue death and gangrene.
�CLASSIFICATION OF ARTERIAL VASCULAR OBSTRUCTION �
1. PARTIAL OBSTRUCTION
This will lead to chronic ischemia is characterized by loss of skin hair, which appear glossy and pits. There is atrophy of muscles and osteoporosis.
�2. COMPLETE OCCLUSION �
Lead to acute ischemia characterized by severe pain , cold and dusky limb and gangrene.
COMMON AREAS OF ARTERIAL OCCLUSION
THROMBUS
COMMON ILIAC A.
POPLITEAL ARTERY
GANGRENE OF TOES DUE TO ISCHAEMIC VASCULAR DISEASE
�CLINICAL FEATURES ��
Symptoms:
1. Predisposing factor (arterial injury or heart disease)
2. Pain
4. Paralysis and Sensation loss
5. Progressive loss of temperature
6. Pulselessness
7. Claudication : Pain in the limbs on walking or exercise.
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�SIGNS�
1. Color of limb is pale
2. Cold
3. Buerger’s test: elevation of affected limb causes blanching and cyanosis and angle of limb to the horizontal is recorded as Buerger’s angle.
4. Allen test: Patient self-extrangunate limb by making fist then ulnar and radial arteries are occluded, then one is released at a time to demonstrate its occlusion or patency.
�INVESTIGATIONS�
SPECIFIC
1. X-ray: there may be calcification of vessels
2. Angiography demonstrate the obstructed vessel.
3. Magnetic Resonant Angiography will demonstrate the vascular pathology and obstruction.
4. ULTRA SOUND such as Doppler ultrasound will demonstrate flow in vessels and obstruction.
5. Ankle – Brachial Index (ABI)
ABI= Mean arterial pressure of arm
Mean arterial pressure of calf = 0.8 to 1(Normal)
critical level is 0.45 (limb survival <50%)
MAP=1/3(SBP-DBP) +DBP OR
MAP=1/3SBP+2/3DBP 0R
MAP=(2DBP+SBP)X1/3
�NON-SPECIFIC INVESTIGATIONS �
1. Heamatocrit
2. FBS
3. Cholesterol Assay
4. ECG to rule out ischemic heart disease
5. Chest X-ray
6. Renal Function test.
�TREATMENT �
1. RESTORATION OF BLOOD FLOW
a. Repair of injured artery
b. removal of occlusion within (thrombus)/thrombolectomy or
without (occlusion from ligature or tumor)
c. Artherio-plasty to widen the artery
d. By-pass surgery to by-pass obstruction
2. TREATMENT/ CONTROL OF COMORBID FACTORS
a. control of Diabetes mellitus Hypercholesterolemia and hypertension
b. Stop the use of cigarette and alcohol
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�CONCLUSION �
Ischemic vascular disorder is a threat to the limb/tissue survival and will require prompt evaluation and restoration of blood supply and subsequently the treatment of co-morbid factors.
FOOD FOR THOUGHT
THE BRITISH UPPER CLASS BELIEVES IT A THING OF POISE, GRACE AND SOMETHING WORTH DISPLAYING WHEN YOUR CHILDREN EXHIBIT POLITENESS COURTESY AND GOOD MANNERS.
IN THEIR OWN OPINION,CHILDREN WHO LACK GOOD MANNERS ARE OF THE COMMONERS
GOOD MANNERS WILL TAKE YOU WHERE YOUR EDUCATION CAN’T IRRESPECTIVE OF YOUR STATUS,MONEY OR THE WHO YOU KNOW FACTOR
QUESTIONS?