الخاصة كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD FRCS wwwsurgiguidecom 2 nd lecture ID: 779638
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الجامعة السورية الخاصة
كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطانMD – FRCSwww.surgi-guide.com2nd lecture
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M.A.Kubtan
Slide2Acute Arterial Occlusion
Definition :Is sudden occlusion of an artery commonly caused by Emboli , or Thrombus .M.A.Kubtan2
Slide3Definition Embolus
: Is an abnormal mass of undissolved material which is transported in the circulation from one part to another .Thrombus : Is thrombotic lesion occurs on a plaque of pre-existing atheroma ending with complete acute occlusion of the artery . M.A.Kubtan3
Slide4Classification of Embolism Thrombi and clot may be bland or infected.
Gas : Air and Nitrogen .Fat .Tumour .Miscellaneous .M.A.Kubtan4
Slide5Embolic OcclusionIt is often a thrombus that has become detached from the Lt Atrium in cardiac
arrhythemia ( atrial fibrellation , or mural thrombus following myocardial infarction .Less common are aneurysm and thrombi formed on atheromatous plaques causing artery to artery embolism .M.A.Kubtan5
Slide6Clinical features of Arterial Occlusion It is an emergency and requires immediate treatment
Leg >>>> pain , pallor >>>> parisis >>>> pulslessness ,paraesthesia ( anaesthesia ) . The limb is cold and toes cannot be moved in contrast with venous occlusion when muscle function is not affected .The diagnosis can be made on clinical bases .Symptoms may progress to complete loss of function , coldness and mottling.M.A.Kubtan6
Slide7Types of embolism and complicationsCompartment syndrome .
Intra-arterial thrombosis .Mesenteric artery occlusion .Air embolism .Bacterial infected clot embolism .Malignant cells ( Hypernephroma , Cardiac myxoma ) Fat embolism .Therapeutic embolisation.M.A.Kubtan7
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Slide11TreatmentTotal heparinisation
( Intravenous Heparin 5000 U ) .Relief of pain since it is sever and constant .Thrombolysis when indicated .Embolectomy .M.A.Kubtan11
Slide12Abdominal Aortic ThrombosisM.A.Kubtan
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Slide14Fogarty catheter for removal of EmbolusM.A.Kubtan
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Slide15Removal of organized thrombusM.A.Kubtan
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Slide16Saddle Aortic ThrombosisM.A.Kubtan
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Slide17Thrombus removed from SFA & POP AM.A.Kubtan
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Slide19GANGRENE
Implies death of macroscopic portion of tissue It is often affects distal part of limb because of arterial obstruction .Gas gangrene caused by anaerobic infection . M.A.Kubtan19
Slide20Clinical featuresAbsent arterial pulsation .
Absent venous return.Absent capillary response to pressure .Absent sensation .Absent warmth .Absent function .Changes in colour : Pallor , duscky grey ,mottled , purple >>> dark-brown , greenish-black ,black.M.A.Kubtan20
Slide21Types of gangreneDry gangrene .
Moist gangrene the affected part becomes swollen ,and discoloured . Crepitus may be palpated .this condition is quite common in feet of diabetics.M.A.Kubtan21
Slide22Specific varaieties of gangree
Diabetic gangrene .Bedsores .Drug abuse .Injecting of drugs into arteries .Frost bite .Venous gangrene M.A.Kubtan22
Slide23Frostbite of the foot note the clear demarcation lineM.A.Kubtan
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Slide26Treatment of gangreneAccording to stage .
In diabetic gangrene : Oxygenation , Antibiotics ,Extensive debridement.Amputation .M.A.Kubtan26