Basic principles of vascular surgery Anatomy Physiology Pathology Pathophysiology Clinical presentation.History, physical exam. investigation management

physiology Haemostasis vasoconstriction platelet aggregation Coagulation intrinsic, extrinsic Fibrinolysis Renin angiotensin system

Vascular pathology Atherosclerosis: placque formation,flow effect, fate of the placque Risk factors Clinical sequelae : stenosis, occlusion, thrombosis, embolisation, aneurysm

Vascular pathology 1-Trauma:RTA,falls, stabs, gun shot, sharps Iatrogenic DRUG ADDICT 2-Inflammatory: (VASCULITIS) Takayassaue, Kawasaki, Beurger Connective tissue (SLE, polyart. Nod., Rh. Art.,) 3-Spasmodic Reynauds dis., phenomenon 4-Conginetal malformation : venous, arterial AVM

symptomatology Chief complaint, history of the present illness Peripheral vascular symptoms atherosclerosis risk factors Review of important systems

Peripheral vascular symptoms Acute ischaemia Chronic ischaemia Infection Neuropathy Foot trauma/injury Syndromes amaurosis fugax, dysphagia lusoria, Leriche, TIA, CVA

Atherosclerosis risk factors Nonmodifiable age, gender, family Modifiable D.M., Hypertension, Smoking Dyslipidaemia, obesity, stress

Review of systems Cardiac Cerebral Renal Gastrointestinal

Renovascular hypertension 10-20%of secondary hypertension Uncontrolled despite 2-3 meds Flash pul.oedema Hypokalaemia Captopril test Doppler US., MRA Angioplasty

Examination Pulse, B.P., Edema Local inspection Colour elevation, dependency Skin trophic changes Driness, hair, nails, wasting venous filling Ulcers, Gangrene

Ulcers def., types Gangrene infarction Necrosis

Examination Palpation temp. pulses, cap. Filling Auscultation carotid, femoral

Investigation Bood work, ECG, CXR Non invasive vascular lab ankle/brachial index exercise test, toe pressure doppler ultrasound Invasive angiography, CT, MRA

Medical Management 1-Risk factors control 2-improve blood flow aspirin, pentoxyphylline clopidogrel, anticoagul.

Aspirin mechanism of action Phosphlipids---arachidonic acid----(cyclo- oxygena)--endoperoxides: In plt thromboxane(throm.synth) ATP-----ADP(plt aggreg.+vasocons) In blood vessel endoth. Endoperox.----prostacyclin(stimulate adenyl cyclase) ATP------cAMP(plt sgreg.+vasodil) AMP (phosphodiesterase)

Surgical management For rest pain, ulcers, gangrene Embolectomy, thrombectomy, Vascular reconstruction Endart.,repair, resection+interposition,Bypass Using saphenous vein (reverse/insitu)or PTFE Amputation toe, transmet., symes,BK,AK