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الجامعة السورية الخاصة. كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD – FRCS www.surgi-guide.com 3 rd lecture . Medical support in chronic arterial iscaemia. Medical treatment for associated disease such as diabetes , hyperlipidemia.
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الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD – FRCS www.surgi-guide.com 3rd lecture M.A.Kubtan
Medical support in chronic arterial iscaemia • Medical treatment for associated disease such as diabetes , hyperlipidemia. • Beta blockers may exacerbate claudication . • Anti platelet agent , aspirin , clopidogrel as an alternative . • Vasodilators are unlikely to be beneficial. M.A.Kubtan
Collateral vessels develop 6 months after an occlusive episode . Intermittent claudication considered relative indication for interventional or conventional treatment . Rest pain considered an absolute indication for interventional or conventional treatment . M.A.Kubtan
Stenos left renal arterya. before dilatation , b. after balloon dilatation M.A.Kubtan
Stent deployment M.A.Kubtan
Arterial stent M.A.Kubtan
Operation for arterial stenosis or occlusion • Site of disease • Aortoiliac occlusion . • Aorto femoral occluaion. • Superfacial femoral artery occlusion . • Popleteal occlusion . • Posterior tebial artery occlusion . • Type of operation • Aortoiliac bypass . • Aortofemoral bypass . • Femoropopleteal bypass. • Femorodistalpopleteal bypass. • Femorodistal bypass . M.A.Kubtan
Types of bypass grafts • Autogenoussaphenous vein ( as reversed conduit or in situ after valve disruption ). • Dacron graft . • PTFE ( polytetrafluroethylene ) graft . • PTFE ( rings supported ) . • Human umbilical vein treated graft . M.A.Kubtan