Peripheral Vascular Diseases

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Peripheral Vascular Diseases

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Thromboangitis Obliterans(Buergers Disease)

• ETIOLOGY
• External---cigarette smoking,frigid
  irritation,injury,infection,sexual hormone, etc
• Internal---hereditary susceptibility
  ,autoimmune disease,high coagulation status of
  blood,etc

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• PATHOLOGY
• (1)invading middle and small arteries and
  veins,common on lower limb
• (2)artery---sclerosis,stricture,occlusion(seg
  mental distribution)
• (3)perivascular inflammationinfiltration of
  inflammatory cells,proliferation,fibrosis,etc
• (4)changes of veins---inflammation,thrombosis
  ,fibrosis,etc

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• CLINICAL PRESENTATION
• mainly including(1)tiredness,intermittent
  claudication(2)pain,numbness,silent(rest)pain(3)
  migratory supperficial thrombo-
• phlebitis(4)decrease or loss of arterial
  pulse (5)ischemic arterial ulcer, dry wet
• gangrene.

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• Three stages are divided according to the extent
  of arterial ischemia disease status (natural
  history)
• 1st stage Local Ischemiafunctional spasm
  stricture of artery.
• 2nd stage Nutritional Dysfunctionsevere
  stricture occlusion of artery.
• 3rd stage Necrosis Gangrenecomplete
  occlusion of artery.

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• DIAGNOSIS
• history symptoms signs special exam
• Buergers test
• Doppler ultrasound
• Angiography (DSA)
• MRA

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• DIFFERENTIAL DIAGNOSIS
• atherosclerosis obliteration (ASO,???????)
• acute arterial embolism(??????)
• multiple arteritis(???????)
• diabetic foot(????,??????)
• Raynauds syndrome(?????)

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• TREATMENT
• Nonsurgical therapy
• cessation of cigarette smoking
• functional exercises
• vasodilators analgetics
• anticoagulants
• high-pressure oxygen therapy
• Chinese medicine

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• Surgical therapy
• lumbar sympathectomy
• PTA (percutaneous transluminal angioplasty)
• arterial bypass procedures
• arteiovenostomy
• amputation

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Venous Diseases of Lower Extremity

• INTRODUCTION
• General division reflux, occlusive
• Classification
• Diagnosis

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• Simple Varices of Lower Extremity
• great saphenous varices
• 1.ETIOLOGY
• congenital venous abnormality
• high venous pressure

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• 2.PATHOLOGY
• venous valve atrophy or loss? reflux of venous
  blood and sludging of blood ?skin pigemntation ,
  anoxemia of local tissue ?
• dermatitis, erosion , ulcer, etc
• 3.PRESENTATION
• mainly manifestationsuperficial venous twists
  and turns, segmental dilitation.
• dermatitis, erosion, ulcer

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• 4.DIAGNOSIS
• clinical presentations adjuvant exam.
• Trendelenburgs test
• Perthes test
• Pratts test
• Angiography (venous)
• Differential Diagnosis

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• TREATMENT
• Nonsurgical therapy
• avoid standing for a long time
• wear elastic stockings
• sclerosing therapy
• drugs
• Surgical therapy
• ligating stripping the great or/and
• lesser saphenous vein its branches

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Primary Incompetence of Deep Venous Valve of
Lower Limbs

• DEFINITION
• CLINICAL PRESENTATION
• similar to simple venous varices of lower
  extremity, but the symptoms are more severe
• DIAGNOSIS
• doppler ultrasonogrphy
• photoelectric plethysmography
• venous angiography (antegrade retrograde)

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• TREATMENT
• nonsurgical therapy
• surgical therapy
• valve repair secondary lesion
  management (e.g.ligationstripping of great
  saphenous vein)

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