周围血管疾病.ppt

❖ DIFFERENTIAL DIAGNOSIS atherosclerosis obliterationБайду номын сангаас(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）
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
❖ Surgical therapy lumbar sympathectomy PTA (percutaneous transluminal angioplasty) arterial bypass procedures arteiovenostomy amputation
Venous Diseases of Lower Extremity
Internal---hereditary susceptibility ， autoimmune disease，high coagulation status of blood，etc
❖ PATHOLOGY
（1）invading middle and small arteries and veins，common on lower limb
dermatitis, erosion , ulcer, etc
3.PRESENTATION
mainly manifestation—superficial venous twists and turns, segmental dilitation.
dermatitis, erosion, ulcer
（2）artery---sclerosis，stricture，occlusion （segmental distribution）
（3）perivascular inflammation—infiltration of inflammatory cells，proliferation，fibrosis，etc
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
❖ INTRODUCTION
❖ General division: reflux, occlusive ❖ Classification ❖ Diagnosis
❖ Simple Varices of Lower Extremity
great saphenous varices 1.ETIOLOGY
（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 thrombophlebitis;(4)decrease or loss of arterial pulse; (5)ischemic arterial ulcer, dry & wet gangrene.
动脉硬化性闭塞症 血栓闭塞性脉管炎
发病年龄 血栓性静脉炎 高血压、冠心病、高 脂血症、糖尿病 受累血管 其他部位动脉病变 受累动脉钙化 动脉造影
多见于45岁以上 无 常见
大、中动脉 常见 可见 广泛性不规则狭窄和 节段性闭塞，硬化动 脉扩张、扭曲
青壮年多见 常见 常无
中、小动静脉 无 无 节段性闭塞，病变近、 远侧血管壁光滑
Three stages are divided according to the extent of arterial ischemia &disease status (natural history):
1st stage: Local Ischemia—functional spasm & stricture of artery.
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 →
❖ TREATMENT ❖ Nonsurgical therapy
cessation of cigarette smoking functional exercises vasodilators & analgetics anticoagulants high-pressure oxygen therapy Chinese medicine
4.DIAGNOSIS clinical presentations + adjuvant exam. Trendelenburg’s test Perthes’ test Pratt’s test Angiography (venous) Differential Diagnosis