" وقل ربي زدني علما ً "

1. بسم الله الرحمن الرحيم " وقل ربي زدني علما ً "

2. MANIFESTATIONS OF VASCULAR DISEASES Prof. Hasan Ali Al Zahrani, FRCS Professor of Surgery, Consultant Vascular Surgeon King Abdulaziz University, Jeddah (www.profzahrani.com)

3. Arterial Problems 1.Aneurysms : - AAA - peripheral 2. Limb ischaemia : - acute - chronic 3. Vasculitis : - Types - Thromboangitis obliterans 4. Carotid artery disease : 5. D.M. foot :

4. Venous Problems • Varicose veins • D.V.T. & postphlebitic limb • Leg ulcers

5. Others • Vascular malformations • Angioaccess • Thoracic Outlet Syndrome • Vascular Trauma

7. Aneurysms Definition : Localized dilatation of an artery or vein • The commonest is AAA • Rare in veins • Usually due to ATO

8. Symptoms : • Most are asymptomatic • Intermittent claudication (if there is occlusive disease) • Trash foot or blue toes syndrome (if embolizing) • Severe abdominal and/or back pain (if leaking) • Shock (if ruptures)

9. Signs : • Pulsating epigastric mass – AAA • Pulsating iliac mass - ? Iliac • Examine other arteries 5-10% associated aneurysms • Abd. tenderness • Shock

11. Acute Limb Ischaemia • Sudden cessation of blood flow to lower or less frequently upper limb which is usually due to embolism or trauma and less frequently due to thrombosis.

12. A.L.I. Causes : • Embolism : a. Cardiac : very common - A.F. - M.I. in I.H.D. - Rh. H. D - Others b. Non-cardiac : - atheromatous plaques - aneurysm - trauma

13. A.L.I. • Thrombosis : a. Acute or chronic (? I.C.) b. Aneurysms c. Severe D.V.T. (P.C.D.)

14. A.L.I. Symptoms & Signs : • The 5 P’s • Coldness • Poor capillary refilling • Rigor (late signs) • Examine other pulses • Heart examination

15. A.L.I. Investigation : • C.W. Doppler • Duplex scan • Arteriography (in selected cases) • ECG, CXR, Echo

16. A.L.I. Management : • Aim to minimize the time lag to less than 8 hours • Establish the underlying cause • Heparin infusion • Surgical embolectomy • Fibrinolytic therapy • ? Primary amputation

18. Chronic Limb Ischaemia (C.L.I.) • Affects usually the lower limbs • Usually due to atherosclerosis • Common in D.M. patients • Symptoms and signs depend on the site of occlusion.

19. Chronic Limb Ischaemia (C.L.I.) Symptoms : • Intermittent claudication :- cramping pain affecting usually the calf muscles which comes with exercise and relieved by rest. (? Distance, radiation) • Rest pain:- severe burning pain affecting the forefoot, coming at rest and relieved by hanging the leg beside the bed • Impotence :- Leriche’s Syndrome

20. Chronic Limb Ischaemia (C.L.I.) Signs : • Ulceration :- painful, no bleeding • Pallor, Buerger’s test, rubor or dependency, capillary re-perfusion • Cyanosis, coldness, trophic changes • Examination of pulses • Listen for bruits

21. (C.L.I.) Investigations : • General including :- R.B.S., lipids, CXR, ECG • Specific:- • A/B index, toe pressure • Duplex scan • MRA, C.T. angio,. • Angiogram

22. (C.L.I.) Indications for surgery : • Disabling I.C. • Critical ischaemia:- I.R.P., ulcer • Impotence • ? Progressive disease

23. (C.L.I.) Medical:- Anti-platelets Control D.M., hyperlip., high B.P. Stop smoking Reduce weight and diet ? Pentoxyfylline Endovascular and surgical :- P.T.A.  stenting bypass endartrectomy amputation

26. Vasculitis Definition : A group of vascular inflammatory disorders sharing immune-mediated reactions but with distinctive clinical picture, e.g. • Thromboangitis obliterans • P.A.N., G.C.A., …etc.

27. Buerger’s Disease (T.A.O.) : - Vasculitis of small and medium-sized veins and arteries affecting mainly young and middle-aged males who smoke heavily. Its aetiology in unknown.

28. Buerger’s Disease (cont) : - Management : • Diagnosis (including diff. Diag.) • Stop smoking • Vasodilators • Sympathectomy • Bypass • Amputation

30. Carotid Artery Disease (CAD) Symptoms : • TIA • PRIND • Amurosis fugax • Stroke • Blindness Signs : • Carotid bruit • Neurological deficits

31. C A D Diagnosis : • Duplex scan • MRA • CT • Carotid angio

32. C A D Management : • Medical : - Antiplatelets - Anticoagulants - Control risk factors • Carotid Endartrectomy • ?? Angioplasty

34. D M F • High incidence of D.M. in S.A. • The most common indication for amputation • Factors : • Ischaemia : 40% • Neuropathy : 60% • Infection : 90%

35. D M F Diagnosis :- • For Infection :- - CBC, culture, x-ray of foot • For Ischaemia :- - Toe pressure, Duplex scan, Angio • For Neuropathy:- - EMG

38. D M F Prevention :- Management : - • Medical : - control of D.M. & hyperlipidaemia - antibiotics - Antiplatelets 2. Surgical : - Debridement + drainage - Vascular reconstructive procedure - Skin grafting - Amputation

39. Thank You !!!