Presentation 11.pptx..........................

Medical content

1. Arterial disease Chronic arterial occlusion

2. Diseases of arteries Atherosclerosis . Thromboangiitis obliterans (TAO) (Buerger's disease). Raynaud's disease. Conditions causing Raynaud's phenomenon: Like sclero-derma, rheumatoid arthritis Embolus. Aneurysms. Other causes: Fibromuscular dysplasia, radiation, Takayasu's arteritis.

3. ATHEROSCLEROSIS It is a chronic, complex inflammatory condition of elastic and muscular arteries, involving as systemic and segmental. It begins in childhood as fatty streaks.

4. Pathogenesis

5. Pathogenesis

6. Features Common after 50 years (but may occur earlier) Affects both sexes; family history is common Risk factors: Smoking, Hypertension, Diabetes, Hyperlipidemia Arteries affected, not veins → arterial wall thickened on palpation Thrill & bruit over femoral/renal/carotid arteries → indicates stenosis & turbulence Ischemic features in limb: absent/feeble pulses (including femorals) Abdominal exam: check for aortic aneurysm Systemic involvement: TIA, angina, visual problems, mesenteric ischemia, renal dysfunction

7. Evaluation Investigations: Blood sugar, fasting lipid profile Doppler, CT/DSA angiogram, US abdomen ECG, Echocardiography Angiogram: shows site, extent, % stenosis, collaterals Antiphospholipid Antibody Syndrome (APLS) 🧪: Autoimmune hypercoagulable state (arterial + venous thrombosis) Clinical: stroke, limb DVT, recurrent pregnancy loss Diagnosis: ELISA for APLA Treatment: Aspirin + Warfarin

8. Complications of atherosclerosis

9. INTERMITTENT CLAUDICATION It is a crampy pain in the muscle seen in the limbs Pain commonly develops when the muscles are exer­cising. Cause for pain is accumulation of sub­stance P and metabolites. Normally During exercise increased perfusion and increased opening of collaterals wash the metabolites.

10. LIMB ISCHAEMIA Causes Atherosclerosis. Embolism (acute). Arteriopathies—Buerger’s disease, Raynaud’s disease,Takayasu’s disease. Diabetes. Scleroderma. Physical agents—trauma, tourniquet, radiation injury.

11. Critical Limb Ischaemia It is persistently recurring ischaemic rest pain for 2 weeks , which requires regular analgesics for > 2 weeks or ulceration or gangrene of the foot or toes with an ankle systolic pressure < 50 mmHg or toe systolic pressure < 30 mmHg. Ankle brachial pressure index (ABPI) will be less than 0.3.

12. >0.90 is normal 0.70–0.89 is mild disease 0.50–0.69is moderate <0.50 is severe.