血管外科2課件

VASCULRDISEASESVenousVaricose

什么下肢靜脈曲張以下肢淺靜脈迂曲擴(kuò)張為主要表現(xiàn),有時(shí)伴有色素沉著、水腫甚至潰瘍的一組癥候群。不是一種疾病，而是一組疾病前言原發(fā)性靜脈曲張(又稱單純性下肢靜脈曲張)原發(fā)性深靜脈功能不全髂靜脈壓迫綜合征深靜脈血栓形成后綜合征布加綜合癥下肢動(dòng)靜脈瘺等等AnatomyofLowerLimbVeins1.Deepveins:venousvalves2.Superiorveins3.PerforatorsLowerextremityvenousvaricoseSuperficialvaricoseveinsoflowerextremity,greatsaphenousveinand/orlessersaphenousveinLowerextremityvenousvaricose1.Clinicalmanifestationssuperficialvaricoseveins,edema,pigmentation,ulcer,andsoon.2.Complicatedrelateddieasesthromboangitis,ulcer,bleeding3.physicalexamination:Trendelenburgtest,Perthestest,Pratttest4.Imagingfinding:ultrasonography–femosaphenousvenousvalvesinsufficiencyLowerextremityvenousvaricose.Differentiation:(1)primarydeepvenousinsufficiency(2)postthrombosissydrome(3)arteriovenousfistula6.Treatment:(1)nonoperativetherapy(2)injection(3)surgeryPrimarydeepvenousinsufficiencyPrimarydeepvenousinsufficiency

Thedeepvenousvalvescannotpreventbloodrefluxing.

Etiologyandpathophysiology:(1)structurefailure,(2)hyperloadofbloodreturn,(3)venousvalvesmalformation,(4)musclepumpdysfunctionNormalvein(autopsy)VenousvalvesClinicalmenifestationsuperficialvaricoseveins,edema,pigmentation,pain,ulcer,andsoon.philibitisPhlibitis&pigmentationCapillaryenlargmentVaricoseVeinexamination1.

Ultrasonography2.

Asscendingvenography:3.

PressuredetectionAsscendingvenographyAsscendingvenographyAsscendingvenographyAsscendingvenographyAsscendingvenography

Differentiation(1)superficialvaricosevein(2)postthrombosissydrome(3)arteriovenousfistula.TreatmentNonoperativetherapy:1.Elasticstocksorbandage2.drugs:Operation:(1)repairofthe1stvalvesuperficialfemoralveinbyvenotomy(2)externalbandingvalvuloplasty,(3)valvulartransplantation,(4)muscularloopsubstitutevalveoperationDEEPVENOUS

THROMBOSISEtiologyandpathophysiologyBloodcoagulationoccursabnormallyinthedeepveins,venouscanalwasblocked,bloodcannotreturnnormally.(1)Virchowtheory(2)riskfactorsClinicalmenifestation:

(1)differenttypedifferentmanifestationa.iliofemoralvenousthrombosis,b.peripheraltype:thrombosisofpoplitealanditsbranches.c.mixedtype:thrombosisofwholelimb..（1）周圍型

（2）中央型

（3）混合型Clinicalchangesofthedisease:a.completeobstruction,b.partialrecovery,c.recoveryd.rethrombosis

Diagnosis(1)d-dimer(2)plethysmograhy(3)ultrasonography(4)radionuclid(5)ascendingvenography

ascendingvenographyascendingvenographyascendingvenographyTreatment

generaltreatment(1)Drugtherapy:thrombolysis,anticoagulateandsoon.(2)

Catheterdirectedthrombolysis(3)

Operation:thrombectomyindication導(dǎo)管溶栓Complication:pulmonaryembolism:IVCfilterpostthrombosissyndrome:venousvaricose,pigmentation,ulcer,etc.血栓后髂靜脈仍梗阻病人

動(dòng)脈硬化閉塞癥

AtherosclerosisObstruction（ASO）

DefinitionSystemicdiseaseVascularcanalstenosisorobstrctioncausedbyatherosclerosisofarterywallMajorandmediatearteriesareinvolvedExamples:aortoiliacASO,femoralpoplitealASORiskFactorsHypertensionHyperlipoidemiaDiabetesmellitusObesitySmokingNormalarteryNormalarteryClinicalmenifestationIntermittentclaudicationlowerlimbmuscles,skinandsubcutaneousatrophyRestpainUlcerandgangereneImpotenceEmergencycondition:arterythrombosis,acuteischemicchangesASOExamination(location,range,degree,outflowandcolateralcirculation)Noninvasivevascularexamination:ultrasonography,ABI,etc.CTA,MRADSADifferetiationdiagnosisBuerger’sdisease(thromboangiitisobliterans)Takayasu’sdisease:nonspecificaortoarteritisTreatment(nonoperation)NosmokingDietcontrolSportsDrugs:aspirin,prostaglandin(PGs),etcTreatment(operation)EndovasculartreatmentEndaterectomyThromboembolectomyBypasssurgeryAmputationangioplastywithstent

病例（取栓）POSTOPERATIONPOSTOPERATIONPOSTOPERATIONThromboangiitisobliterans(TAO)

Buerger’sdiseaseBasicinformationDefinition:anonatheroscleroticsegmentalinflammatorydiseasethatmostcommonlyaffectsthesmallarteriesandveinsintheupperandlowerextremities.---vasculitisEtiologyandRiskFactors:

SmokingGeneticsHypercoagulabilityandendothelialfunctionImmunologicmechanismsClinicalfeaturesYoungmalesmokerswithonsetofsymptomsbefore40to45yearsold.Intermittentclaudicationoffeet,occasionallythearmsandhandsRestpainIschmiculcerandgangreneThrombophlebitis,raynaud’sphenomenonandsensoryfindingcanbefoundoccasionally.Arteriographicfindings

InvolvementofsmallandmediumsizedvesslsSegmentalocclusivelesions:diseasedarteriesinterspersedwithnormal-appearingarteriesMoreseverediseasedistallyCollateralizationaroundareasofocclusion:corksrewcollateralsNormalproximalarteries:noatherosclerosisNosourceofembolusDiagnosisYoungmale,tobaccoabuse,ischemicsymptomsandsigns,autoimmunediseases,confirmedbyarteriographicfindings.TreatmentNosmokingExercisesDrugtherapySurgicaltreatmentARTERIALEMBOLISM

Definition

Bloodclotorothersblockingthebloodflowintheperipheralarteries.Theheartisthemainsourceoftheemboli,especiallyinthepatientswithatrialfibri