الجامعة السورية الخاصة كلية الطب البشري قسم الجراحة الدكتور عاصم قبطان
الجامعة السورية الخاصة
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Transcript of الجامعة السورية الخاصة
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السورية الخاصة الجامعة
البشري الطب كليةالجـراحـة قسم
قبطان عاصم الدكــتـورMD – FRCS
www.surgi-guide.com
2nd lecture
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Acute Arterial Occlusion
Definition :Is sudden occlusion of an artery
commonly caused by Emboli , or Thrombus .
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Definition
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 .
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Classification of Embolism
1. Thrombi and clot may be bland or infected.
2. Gas : Air and Nitrogen .3. Fat .4. Tumour .5. Miscellaneous .
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Embolic Occlusion
It 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 .
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Clinical features of Arterial Occlusion It is an emergency and requires immediate
treatmentLeg >>>> 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.
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Types 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.
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TreatmentTotal heparinisation ( Intravenous
Heparin 5000 U ) .Relief of pain since it is sever and
constant .Thrombolysis when indicated .Embolectomy .
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Abdominal Aortic Thrombosis
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Fogarty catheter for removal of Embolus
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Removal of organized thrombus
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Saddle Aortic Thrombosis
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Thrombus removed from SFA & POP A
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GANGRENE
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 .
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Clinical 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.
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Types of gangrene
Dry gangrene .Moist gangrene the affected part
becomes swollen ,and discoloured . Crepitus may be palpated .this condition is quite common in feet of diabetics.
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Specific varaieties of gangree
Diabetic gangrene .Bedsores .Drug abuse .Injecting of drugs into arteries .Frost bite .Venous gangrene
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Frostb
ite of
the f
oot
note
the c
lear d
emarc
ation
line
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Treatment of gangrene
According to stage .In diabetic gangrene : Oxygenation ,
Antibiotics ,Extensive debridement.Amputation .