Basic principles of vascular surgery

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Basic principles of vascular surgery

• Anatomy
• Physiology
• Pathology
• Pathophysiology
• Clinical presentation.History, physical exam.
• investigation
• management

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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 pathology

• 1-TraumaRTA,falls, stabs, gun shot, sharps
  Iatrogenic
• DRUG ADDICT
• 2-Inflammatory (VASCULITIS) Takayassaue,
  Kawasaki, Beurger
• Connective tissue (SLE, polyart. Nod., Rh.
  Art.,)
• 3-Spasmodic Reynauds dis., phenomenon
• 4-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

• 10-20of 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 ultrasound
• Invasive 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 action

• Phosphlipids---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 reconstruction
• Endart.,repair, resectioninterposition,Bypass
• Using saphenous vein (reverse/insitu)or PTFE
• Amputation toe, transmet., symes,BK,AK