周圍血管疾病

1、vETIOLOGY External-cigarette smoking，frigid irritation，injury，infection，sexual hormone， etc Internal-hereditary susceptibility ，autoimmune disease，high coagulation status of blood，etcvPATHOLOGY （1）invading middle and small arteries and veins，common on lower limb （2）artery-sclerosis，stricture，occlusi

2、on（segmental distribution） （3）perivascular inflammationinfiltration of inflammatory cells，proliferation，fibrosis，etc （4）changes of veins-inflammation，thrombosis，fibrosis，etc vCLINICAL PRESENTATION mainly including(1)tiredness,intermittent claudication;(2)pain,numbness,silent(rest)pain;(3)migratory s

3、upperficial 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 Ischemiafunctional spasm & stricture of artery.

4、2nd stage: Nutritional Dysfunctionsevere stricture &occlusion of artery. 3rd stage : Necrosis & Gangrenecomplete occlusion of artery.vDIAGNOSIS history + symptoms & signs + special exam: Buergers test Doppler ultrasound Angiography (DSA) MRAvDIFFERENTIAL DIAGNOSIS atherosclerosis obliter

5、ation (ASO,動脈硬化閉塞癥） acute arterial embolism（急性動脈栓塞） multiple arteritis（多發(fā)性大動脈炎） diabetic foot（糖尿病足，糖尿病性壞疽） Raynauds syndrome（雷諾綜合征）動脈硬化性閉塞癥血栓閉塞性脈管炎發(fā)病年齡多見于45歲以上青壯年多見血栓性靜脈炎無常見高血壓、冠心病、高脂血癥、糖尿病常見常無受累血管大、中動脈中、小動靜脈其他部位動脈病變 常見無受累動脈鈣化可見無動脈造影廣泛性不規(guī)則狹窄和節(jié)段性閉塞，硬化動脈擴(kuò)張、扭曲節(jié)段性閉塞，病變近、遠(yuǎn)側(cè)血管壁光滑vTREATMENTvNonsurgical the

6、rapy cessation of cigarette smoking functional exercises vasodilators & analgetics anticoagulants high-pressure oxygen therapy Chinese medicinevSurgical therapy lumbar sympathectomy PTA (percutaneous transluminal angioplasty) arterial bypass procedures arteiovenostomy amputation vINTRODUCTIONvGe

7、neral division: reflux, occlusivevClassification vDiagnosis vSimple Varices of Lower Extremity great saphenous varices1.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 lo

8、cal tissue dermatitis, erosion , ulcer, etc3.PRESENTATION mainly manifestationsuperficial venous twists and turns, segmental dilitation. dermatitis, erosion, ulcer 4.DIAGNOSIS clinical presentations + adjuvant exam. Trendelenburgs test Perthes test Pratts test Angiography (venous) Differential Diagn

9、osisvTREATMENTvNonsurgical 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 vDEFINITIONvCLINICAL PRESENTATION similar to simple venous varices of lower extremity, but the symptoms are more severevDIAGNOSIS do