Acute Artesal o CCLuS ion

Sudde o occlus ion fan artery

s Commonly Ca used 6y mbolf.

n- 7hrombos íS
JE Can a lse happen
7hrombo siS b CCu

but ually
pre- existn 9 atheroma,
blag o
blagu
developeq in
P key
IPke ly to hare
(olla t e aals
he
h e effect
eHect
Jenas fs
ma kin 9
artersal
Chronie ess dramatfc
OCcluSi on
of the eve0tual

mbo lic occlusion

that toreign t the

Em bo lus -
a ody
be com e o dged
blood Strea m
Cuhich ma

Cause Obs tru ction

haa VeSse l

Ehrom bus - be come de tached

s o Len
vessal.
amore proximas
heartE (or)
fro m th
Jour -

CardPa c
atrum
Ca
-

e4t amy+hmYa

partf tu larly
Atnal bRlla tion)

O
 th ron bus follow fog
(b) mura myotad ial Jntartieo.

(C) Ane u y s s
A theomato u
on
ThrombP foom ed
(a) plaqus
(So Ca lleq Axtery -to - Art en
embe1Psm

orgon 8 Couse
Em be 17 may lodge an
any
schasmic ympoms

LE Pa i'n
a) Pa 1er
3) Pavesis
9) pulSelessness

s) para e h e s i a .

occlus>on due To an
Nole Atute arteria

embolus t from oCc luson du to

thro m bos7S a pse- exfs#n9 ACheromaa

I'n hom bos7s Colla tera Cfrtu lah on has often

Pxe exR deve lop ovèr tme;

Atheroma

hen ce Claudi Cati on woe but

but
ho dramatc event
 In Em bo l i No 6rstory ef
Claudfcatiorn

Pa tient develops Sudde

all aamasc vents
pain Pateskèa).

8rain
Hajor Mtnor Stoke
monffos ta Hon
TIA - Transien+
Sc haamaA
Atta cks ).
most ommon:- The
HPddle Cerebral artey / 1s
Branches

Re Efnoa

rmanffeo taio0 : AmaumS isugax

Plecing 6/tndness Caued b
fleeing
a mfnu re thrombus emanaEing
trom an atheromatous

plague
in the Carotd ar
tery
dash9 fnto ne Cenéral
obstu cAoN
pesin
passing
Aetinal artery:
Permanan

6 f n d n e s s
 meJen tere
Vess els:

Gangren e Corresbonding

loop e Lntestine

p a in
Sp le en do Ca Iis in 9

Haema t u r
Koin pa in 8
kidn&y
CIPof Cal features lower limbs)
CLA U D ICATloN
HsToRY OF
lo
Severe pain / numboess e
Sudden
he limb

Colo motEle q
imb

more dis4fCult
8 Sensaion
Jensationb
nenh -

move

lost

fo obs truchion
Absen+ p u lse
-
drs a l

ES THES a
P IN, PALoR, PARESIS, PAR
Loss o PuLSAT7oN
T h o m bos is

Atute ThrombosiS octu vessels a/feces7

y Pe- exbin9
AheroSc e roSAS

be eve/opmen
e n era lly -
thare wtll

lolta tera l Istaly

e s u ltant s Chaemia
Hen the
the
lesJevere han
isqten
embolfe rseose. "
Atue

Causes
Distal v a stu lar throm bosiS he

ex tremf ties orcu to dettio9

Seprrs/wfth yper(easubbe

Sta fes aSSoC iated

Common Hyper (oaqu la ble
h o m bos i are
Arterfal
wfth A cu Te
Ant?-7hrom bin- deficien y.
a)
a)

6) upus
6) Anti Coagulant
Pro t en eflcien ty
) -
c
 ovesti9ations:-
Test ne lavant f
i a befe, Abnormal
q.7enera loVesi9ations: lPpid m e f a b o / l sm

Anaem fa 8 Condions
a)Full bloeol Count Caustng bigh blo o7
Viscosf y "
Cincluding plarle!s)

6 plaSma frbrinogoo loo lytyhemia,

Th rom bo-
c)Blood uroe futose pen

d) 8lood kfptd prosle

tal Choles
To terf,
(79ly cerfdes,
Cho Leg eart)
kfpoproien
Hias low- dentft,
e) Ech lcho Cand iagram

+) Chest adog raph

9 R e n a l fun
c an teof 8/oed uea

Serum Cocahninu).

Doppler u lho JSound lo od floJ detectson

PLEX Im AG INh :

B- mode ultraJoun d
 prorfdHe an 'mage he ressel
vessel
Th B

Vessef blood od flow, Turhulene

a(lows Sualfsatoo
ColouT Codfog
blood flow on

image )
Dire tion

Ve locf 0f
floc )
tndfcai
Po fots of htgh low generally
a StenasiS

j e cte 0
Rad io opasut
Angography Arterio9TapY he
Soluson in i
a rtersal ree"
approprots Pf
ang Pn
ography&0nly

terven tion b be?n9 (ontemp la ted.

adrtsa ble 6 have
fE is Q+en
Even hen,
a duplex scan t

Arderal drsechoo
HazardS Thromhos?s,
ncton
Haemato ma, Renal dysfu
Allegic ta chon.
 Areno9rams a fntra a r t e i a embo1?> ABRUP7T (ToFA
the aatery wfth a dounded menf Sus a t the SPa dn
azteryy embo lw

V. D 4 -

D9?tal Su bira cton ang iogpby

drgitres the mages
Compu ter System
he fmage before Fnjection Of
allowtn9
a 9 en t f be Su bba cted rom the
Con trost
emovfng
Con Erost fm age,
there
byn ext vaneos
backgound prorfdfn9
9ea ola .

T MRA - magnet i c Resonan e Angog»aphy:.

wfthout h e
mu ltfp lanar maqPn 9
fon?sPo9 aadration
heed for
direce
ateral punchure
Cor)

TREA TmErT

T/ON
ADMINI4TRA
HEPAR IN

ShasPs, a thrombup
Be ca uSe ensutn9
dtstally 8 proxtaly
Con ex tend
the em bolas
t
 fs batio f
Immedia to
admfn

Fntraenoue/
Beparo
5000 unf
extension
he
Reduce
he Sumounar9
smundin9
tenty Of
mainta in a
e mbolqol a n
unttr he
Vess elS
parhcela n
be
be
trea t e d oishel

essenHal
pai R
/ T h e relies 94 Constant )
S severe s8
be tause f

T.Em DolbcTomY
koca/Geneval anaeohesiaa b uused
sed.

The ater tusua lly

temoral)
the emornl), bualgng
bulgtng

wftb Clot, & exposed & helel t SItoge

Pncfsion
Trans verfe
Kong?tud'nal
o

made

o extrude
Clot begtns
wfth he
demoved, together
a
Embolus, wrth the help
FoGARTY BALLoN CaTHETER
 JnciSion
Catket

P o v o k u n d a

Arteriotomy
mbolw
femor

ante

A3Jnt laded
balloo.
Catheke
Embo

femora/

arte
fogoty Ba lloon Jntlatd
ballooo
Cathets Cathelen io
w h a a wd

RemorN9 hhe
embo lus
ProCodne -

wfh P t ba llo on p
a)Catheter
fn trodu ed both proxrma !ly fs all

untfl E deemed bave pa sfed

Pm?t o the clot.
the
the
 fnflatd he (athe te
(b the ba lleon

wfth drawn Slow ly, togehor Cuf

any Obshru cting mae ral (Embae)

aepeae9 unti/
r o Cedure
Cc
bleed?ng O CCu

Hepario therapy o
bost- epe aatively
(4
Contfnued un &PI ong- Ee am
wfth woadafn
antt Coaqulaton
to e d u Ce the Chane of
esta bliS hed
em bo lPs m
furtheer

TNTRA ARTERIAL 7HRom BoLYSIS

2nd fcations;-
2 tsthaemfa - n o t Jo Severe that
immedta te o peraion essenh al.

Pro a duve

Ateo 9*ophy the frcham ?c

Common
Iimb (usua lly via the

fem ora a temy

 Catheter posse L
harUU

o ccluded Vesse
foto he

et embe dde he
wfth ?n he

clot

J plasm?noqen AcHrator)
TPACfSSue
through the
Cathe ter

Caried out
Reqular arteriograms are

f Check on the ex e n t

which, in Su Cc e3S ful Cases,b ackieved

wfth 4 houD
be abandoned fFf
(The
(he method Shou ld
of dPsso luHon
there no prgression
oclot wfth me) .

(ontrafndfcaions 7o thaom bo lyf

(a) Re Cent Stro ke

diahesis
(6 B1eedfn

(t)Pregnan y
(4) Age 8oy ean
po0v)
(as
(as eptu lth a
 Re vasCulansaHon
CompIi ca Hons
Re perfus ion
2schaemia
:
Re perfusion yndrome

Re per fusion injuy -

Cellulor hat
ejuY hat

OCCu o Pt manifes ted at the 6Pme

éfme

perfus ?on b aestored to fschaem fc tissue.

Reasen
aZndu ted by oXy gen
-

derired r e
dadfcals - ?a

6fschaemfc Skele t a l muscle - repefut

?ntra Ce llular fonS

Pons
a v a ely of
0fhey
Structural protiens, en2
enymaJ
&

Componen ts are zeleased throgh

Sacrolemma n to
he lameged
The CPrCu l a i o

Resalt Myo nepho path?c

Syndroma
 tea tur
Haemo dynamfc FnStab?1ft
a
)KacAPC acPdos

c Hype kalemia

y o g lohtn e leased fro m Pnjured

fo To C r t u latopn e leared
Musc/e Ce 11s
Resu lwO9 dok
hro uge kfdneY
out aed b leod Celt
wft
urtne(
globi nuwa

a aepergusism

Cas ts cl evelops ithe RenalL

6tn
myoglo tubul-es

Dive c toxic eLte c on Rena7

Rena
Fubu les

REN AL FAilurE
) AcUTE

e)
e Acute Compart ment Syndrome
 Compor+ment yndome
Jevere JSchae mfa

Celluloar memnbrone
Pe pertuSion
dystun cion
phase

ln Era Ce (la lar

Sdema
£dema In tershtal
The resul from
fnCreaSe d
mfco vas (ula
feimfab1PG s
Tons, water þroñens
Edema develops within
minutes s
prgressin9
digncantly over he nexd dy houm

The amoun+ ef edema depen on

on

fsehaemia
(a period of
underly'n9 Occ/ussive dfseasSe
6
Re raotu lafsatoon
(c Adegua Cy of

MusclE £DEm
 muwcle dema

Con£tnes of a
OSe ofarual Combartment:

Inte xs hal bre Ssue

ase / incaea Je

AcUTEs Com ART mENT SYNDRo mE

presSure fo CreaJes beyond
Capf llaTy
bevgus fon preSSure 3omm H9
ssue perfusion & fmpafed|

ThS ea ds 76 pro lon9 e4 SSue Pscharma

despPte appavent Success tul
e rao (ulassatioo

Treatment

(a) URG E T FASCIO7o mY - t

eleaSe he
Com psOSSio n
 the uSual SP te at which Su ch

Jugey necessary t h e Ca
The anterror é969al
especta Iy -

(ompot menE)

Com paad me Syndrome may

Qut,
But,
thigh he arm
Oc Casio nall f e c t 7he
X

C C L US 1 o N ' -

mESE TERIC AR TERy

be
be eFher
A cue
mesentsc occluSi on may
embo 11 C
thoom bos c
/
-

occlusion:
Throm botc

follo ws pregressive naowinG Vescel.

Jymptom
prgressire weignt ars

Abdomfna! pa in

past-prandial)

deuco Cy fo t

ate Sto9 Dianrhoea Sys e m ?e povolmia

ha emoCon en t rafon
Treat m en t:-

Arterio9raphy
llowed by PerCuta neouD
7rans lumfnal

Ango p lasty CPTA

Cor
d'urgical pa ss
Pthe bowe ha
hon
not alaeady

fnfarCted
Em bol?e occ lus ion

Jour Ce Sm boli unuall4

prese nt Carelfac.

ypton Sudden, Serere abdomfnal

pain wth bOowel empyn9

Cvomi tfng dfarhoea)
Invesh 9ation Angio gmphy
Treatment
usually o4 the
Em be lechomy
mesete re
Supe r o r
arte
Cor)
passSaage
dapao fomy
aphouS
SeCoND Look
A vfablPty o he
to CheckK he
latir to
tndf Ca t e d
d.
ten
1 ndf co
bowel