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)
-----5AMP
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