Peripheral Vascular Diseases 周围血管疾病山东中西医结合大学普外科

Thromboangitis Obliterans （ Buerger‘s Disease ）  ETIOLOGY External---cigarette smoking ， frigid irritation ， injury ， infection ， sexual hormone ， etc Internal---hereditary susceptibility ， autoimmune disease ， high coagulation status of blood ， etc

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

 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.

Three stages are divided according to the extent of arterial ischemia &disease status (natural history): 1st stage: Local Ischemia—functional spasm & stricture of artery. 2nd stage: Nutritional Dysfunction— severe stricture &occlusion of artery. 3rd stage : Necrosis & Gangrene— complete occlusion of artery.

 DIAGNOSIS history + symptoms & signs + special exam: Buerger’s test Doppler ultrasound Angiography (DSA) MRA

 DIFFERENTIAL DIAGNOSIS atherosclerosis obliteration (ASO, 动脉硬 化闭塞症） acute arterial embolism （急性动脉栓塞） multiple arteritis （多发性大动脉炎） diabetic foot （糖尿病足，糖尿病性坏疽） Raynaud’s syndrome （雷诺综合征）

动脉硬化性闭塞症血栓闭塞性脉管炎 发病年龄多见于 45 岁以上青壮年多见 血栓性静脉炎无常见 高血压、冠心病、高 脂血症、糖尿病 常见常无 受累血管大、中动脉中、小动静脉 其他部位动脉病变常见无 受累动脉钙化可见无 动脉造影广泛性不规则狭窄和 节段性闭塞，硬化动 脉扩张、扭曲 节段性闭塞，病变近、 远侧血管壁光滑

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

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

Venous Diseases of Lower Extremity  INTRODUCTION  General division: reflux, occlusive  Classification  Diagnosis

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

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 manifestation—superficial venous twists and turns, segmental dilitation. dermatitis, erosion, ulcer

4.DIAGNOSIS clinical presentations + adjuvant exam. Trendelenburg’s test Perthes’ test Pratt’s test Angiography (venous) Differential Diagnosis

 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

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)

TREATMENT nonsurgical therapy surgical therapy valve repair + secondary lesion management (e.g.ligation&stripping of great saphenous vein)