vascular physiology 3 n.
Skip this Video
Download Presentation
Vascular Physiology 3

Loading in 2 Seconds...

play fullscreen
1 / 39

Vascular Physiology 3 - PowerPoint PPT Presentation

  • Uploaded on

Vascular Physiology 3. Upper and lower extremity arterial conditions other than atherosclerosis. Upper extremity ischemia . Emboli. Heart most likely source of non-atherosclerotic emboli. 10-20% of all cardiac emboli lodge in upper extremity. 70% of all upper ext emboli come from heart.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Vascular Physiology 3' - sandra_john

Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
vascular physiology 3
Vascular Physiology 3
  • Upper and lower extremity arterial conditions other than atherosclerosis.
  • Heart most likely source of non-atherosclerotic emboli. 10-20% of all cardiac emboli lodge in upper extremity. 70% of all upper ext emboli come from heart.
    • Thrombus
    • Tumor
    • Valvular lesions
    • Fairly common
raynaud s disease cold sensitivity
Raynaud’s Disease(Cold sensitivity)
  • Female- most frequent 18-30 years
  • Abnormal vasoconstriction of extremities upon exposure to cold or emotional stress.
  • Intermittent attacks of pallor, cyanosis,then rubor of digits (usually upper), bilateral or symetrical, normal radial and ulnar pulse.
  • No evidence of obstructive disease.
  • Fairly common
raynaud s disease cont
Raynaud’s Disease cont.
  • Treatment
    • Warmth, gloves, socks, avoid cold
    • Vasodilators
raynaud s phenomenon cold sensitivity
Raynaud’s Phenomenon(cold sensitivity)
  • Intermittent pallor, cyanosis, redness,normal. Repeats.
  • Response to cold or emotion.
  • Numbness, tingling, burning may occur.
  • Secondary to such conditions as occlusive arterial disease, systemic scleroderma, thoracic outlet syndrome, pulmonary hypertension, myxedema or trauma.
  • Fairly common
raynaud s phenomenon cont
Raynaud’s Phenomenon cont.
  • Vascular Lab to look for underlying cause of vasoconstriction.
  • Vascular Lab to document vasospasm.
arterial venous fistulae
Arterial/Venous fistulae
  • Surgically constructed for hemodialysis
    • Cimino-Brescia: end to end or side to side anastomosis between the radial artery and cephalic vein at wrist.
    • Prosthetic graft (PTFE)
      • Loop between brachial art and antecubital vein
      • Straight between radial art at wrist and antecubital vein
      • Straight between brachial artery and subclavian vein
      • Common
buerger s disease
Buerger’s Disease
  • Thromboangiitis Obliterans (fairly uncommon)
    • Men <40yrs
    • 99% smoke
    • Affects small and medium arteries, can affect veins also.
    • Inflammation leading to formation of thrombi
    • Tissue necrosis develops early because of poor collaterals in end arteries of fingers and toes.
  • Dissection, thrombosing, Arterial/venous fistulae.
  • Acute ischemia
  • Can happen to upper or lower ext.
  • Fairly common
thoracic outlet syndrome
Thoracic Outlet Syndrome
  • Compression of nerve, artery, or vein in the thoracic outlet area.
  • Area of 1st rib, clavicle, and scalene muscle.
  • A “cervical rib” with or without a fibrous band may be present.
  • Uncommon
types of thoracic outlet syndrome
Types of Thoracic Outlet Syndrome.

True neurogenic: Wasting of muscles of hand and hand weakness, with positive electromyography.

Vascular Thoracic Outlet: an arterial or venous lesion is present on angiography.

Duplex and photocell exam is helpful and most likely ordered before angio.

thoracic outlet types cont
Thoracic Outlet Types cont.
  • Disputed Thoracic Outlet.
    • Weakness, parathesia, pain of hand, arm, shoulder girdle, chest wall, and headache.
    • Eletromyographic test normal.
    • Hand wasting is never found.
    • Patients do not progress to true neurogenic or vascular thoracic outlet.
  • Muscular masses can be present in the upper extremity. Some are vascular and cause bruit.
  • Masses can compress artery or vein.
  • Uncommon
rheumatic autoimmune diseases
Rheumatic/Autoimmune Diseases

Giant Cell Arteritis: Temporal arteritis and Takayasu’s

Can cause arm claudication or Raynaud’s phenomenon. Uncommon

radiation arteritis
Radiation arteritis
  • Inflammation of subclavian and axillary arteries resulting from radiation treatment.
  • Uncommon but is seen
fibromuscular dysplasia
Fibromuscular dysplasia
  • Systemic disorder, smooth muscle hyperplasia, and general disorganization of the arterial wall.
  • Can cause arm claudication. Uncommon
summary upper
Summary upper
  • Common causes for upper art conditions
    • Emboli
    • Cold sensitivity (vasospasm in Raynaud’s)
    • A-v grafts
upper summary cont
Upper summary cont.
  • Somewhat common
    • Buerger’s Disease (men more than women)
    • Trauma
upper summary cont1
Upper summary cont.
  • Uncommon upper ischemia causes
    • Thoracic outlet
    • Tumor
    • Rheumatic/Autoimmune disease
    • Radiation arteritis
    • Fibromuscular dysplasia
non atherosclerotic lower extremity arterial conditions
Non-atherosclerotic Lower Extremity arterial conditions
  • Account for much less lower extremity ischemia than upper extremity ischemia.
  • Causes acute ischemia/ medical emergency
  • Most non-atherosclerotic emboli come from the heart
  • Entire lower extremity can be involved, most occlude lower leg, foot or toes.
  • Heparin, thrombolytic therapy, embolectomy
  • Common
  • Mostly traumatic
  • Infection is most serious complication
  • Can be painful
  • Rarely causes ischemia
  • Occurs more in lower extremity than upper
popliteal artery entrapment
Popliteal Artery entrapment
  • Popliteal artery compression by medial head of gastrocnemius muscle.
  • Young patients
  • With exercise the gastrocnemius muscle contraction compresses artery.
  • Uncommon
  • Dissection, thrombosing, Arterial/venous fistulae.
  • Acute ischemia
  • Can happen to upper or lower ext.
  • Fairly common
arterial venous fistulas
Arterial-Venous Fistulas
  • Can be surgically created in lower ext for hemodyalisis. Occurs less frequently than in upper. Complications: aneurysm, pseudoaneurysm, infection, graft occlusion.
  • Fairly common (more often in arms)
  • Traumatic:
    • Artery and venous connection due to trauma
    • Infection is most serious complication over ischemia
    • Can be painful
raynaud s disease
Raynaud’s Disease
  • Affects upper extremities more significantly than lower.
  • Vasospasm without underlying occlusive or systemic cause.
  • Uncommon in lower
  • All types of arteritis affects upper extremities much more frequently than lower. (Takayasu’s, Giant Cell Arteritis, Polyarteritis or periarteritis.
  • Uncommon to see these listed as cause for lower extremity ischemia, but is possible.
buerger s disease1
Buerger’s Disease
  • Thromboangiitis Obliterans: described as rarely a cause, and accounting for less than 1% of lower extremity vascular disease.
  • Young, male, smokers, digit ischemia
  • Sudden onset
  • Claudication of foot and arch rather than legs.
  • Associated superficial thrombophlebitis
  • Less likely to cause lower ext ischemia than upper extremity ischemia.
advential cyst
Advential Cyst
  • Cyst of advential layer of arterial wall, causing stenosis or occlusion by thrombosing.
  • Can cause claudication
  • Can be surgically drained or bypassed.
  • Can reoccur
  • Uncommon
  • Heparin induced thrombosis
  • Antithrombin III deficiency
  • Abnormal fibrinolytic system
  • Abnormal platelet aggregation
  • Uncommon
hematologic disease
Hematologic disease
  • Polycythemia Vera
  • Thrombocytosis
  • Dysproteinemias.
  • Sudden onset, usually affects digits
  • Hematology consult for therapy
  • Uncommon
summary of lower extremity arterial complications
Summary of Lower extremity arterial complications
  • Common
    • Emboli
    • Pseudoaneurysm (Lower ext arterial injury, does not usually cause ischemia)
summary lower cont
Summary lower cont.
  • Fairly common
    • Popliteal artery entrapment
    • Trauma
    • Arterial – venous fistula
summary lower ext arterial
Summary Lower ext arterial
  • Uncommon in Lower ext ischemia
    • Raynaud’s disease or phenomena
    • Arteritis
    • Buerger’S Disease
    • Advential cyst
    • Hypercoagulability
    • Hematologic disease
references vas phy 3
References Vas Phy 3
  • Slides 1,2,3,4,5 Taber’s cyclopedic Medical Dictionary, Davis 1985
  • Slide 5 Intro to Vascular Ultrasonography, Zwiebel, Saunders, 2000, Pg258
  • Slides 6,7,8 Intro to Vascular Ultrasonography, Zwieber, pgs 259-260. & Handbook of Patient Care in Vascular Disease, 4th Ed., Hallett, Brewster, Rasmussen pgs 238-247
references vas phy 3 cont
References Vas Phy 3 cont
  • Slide 9 Intro to Vascular Ultrasonography, Zwiebel, 2000, pg 259. & Cardiology Clinics, PVD in The Elderly, Breslin Ed., August 1991, pgs 559-560.
  • Slides 10,11 Intro to Vascular Ultrasonography, Zwiebel, 2000, pgs 259-261. & Vascular Diagnosis 4th Ed, Bernstein, Mosby, 1993.
  • Slide 12 Vascular Diagnosis 4th Ed., Bernstein, Mosby, 1993 pg 631
refer vas phy 3 cont
Refer Vas Phy 3 cont.
  • Slides 13,14,15 Cardiology Clinics, August 1991 pgs547-552. & Vascular Diagnosis, Bernstein, pg 631
  • Slides 16,17 Intro to Vascular Ultrasonography, Zweibel, 2000 Pg 260.
  • Slide 20 Handbook of Patient Care in Vascular Disease 4th, Hallett, pg37.
  • Slide 21 Cardiology Clinics, August 1991,pgs 501
reference vas phy 3 cont
Reference Vas Phy 3 cont.
  • Slide 22 Intro to Vascular Ultrasonography, Zweibel, 2000, pg205. & Cardiology Clinics, August 1991 pgs 559-560
  • Slide 23,26 Cardiology Clinics, August 1991, pg501.
  • Slide 27 Cardiology Clinics, August 1991, pgs 501-502/
  • Slide 29 Cardiology Clinics, August 1991, 497-513.