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Vascular STIKES
Vascular STIKES
Blood Vessel
ext. il. a.
com Fem. a.
prof Fem. a.
sup Fem. a.
popl. a.
ant. tib. a.
post. tib. a.
feb. a.
post. tib. a.
Dor. ped. a.
Anatomy and Structures of Blood Vessels
few SMF
Tunica Media
++ + -
++ + +
Tunica Intima
basement-
membrane
Laminar flow
Pressure Pressure
Velocity Velocity
150 150
PRESSURE (mmHg)
100 100
50 STENONIS
50
Normal Stenosis
Other characterities of blood flow
• Arterial systems
• Microcirculation
• Vein
• Limphatic Sistems
Natural History Of Vascular Disease
Early Intervention Late Intervention
Natural History
Angiogenesis/
Quality of Life (%)
Vasculogenesis
Early Diagnosis
& Treatment
CLINICAL HORIZON
Pharmacological
therapy
Secondary
prevention &
rehabilitation
0 30-40 Death
AGE (YEAR)
What is Peripheral Arterial Disease?
• Arteries to lower extremities
become stenosed or
occluded usually by
atherosclerosis
• Most commonly at
bifurcations
PAD - ATHEROSCLEROTIC
ATHEROSCLEROSIS
History
1) The vascular laboratory must answer three basic question :
– Are the symptoms doe to vascular disease
– How extensive is ?
– Where is the disease located with the affected ??
lesions in PAOD
60% of cases are
superficial
femoral lesions
• Hypertension +++
Major risk factor at cerebral level
• Dyslipidemia +++
Major risk factor at coronary level
• Diabetes mellitus ++
Major risk factor for arteries of the
legs
• Obesity +
• Smoking +++
Major risk factor for atherosclerosis
of the leg and coronary arteries
• Sedentary lifestyle
• Stress?
Who is at Risk from PAD?
Non-modifiable factors
• Age +++
• Male sex ++
• Genetic factors
Peripheral Arterial
Disease
Fontaine Classification:
Stage I Asymptomatic:
atherosclerosis developing
Intermittent Claudication 5% 1 in 20
DANGER
Claudication is a manifestation of
multivessel disease of the
heart, brain and legs.
Physical examination
Look at the skin for any abnnormalities & whithin the
skin feels cool, hot or warm to the touch
Feel for pulses in the arteries (grade ?? /location)
Feel for the lymph nodes, thrill, and mass
For both of the legs
Inspeksi
Palpasi
Auskultasi
Diagnosis - Physical
Assessment
• Inspection of limbs
Palpation Auscultation
Normal No Bruit
++
Mild Stenosis Soft Bruit
++
Significant Stenosis Harsh Bruit
+/-
Critical Stenosis Soft Bruit
-/+
Occlusion No Bruit
-
Common Characteristics
• Procedures of examinations :
- The patient must be supine position
- For every 1cm the limb is above the heart, the pressure
decreases by 0.74 mmHg
- The width of the cuff is :
- 20% - 25% greater than the width of the limb
- 40% greater than the circcumference of the limb
- At least 20 mmHg post the disappearance a Doppler –
detected pulse
- The first flow of blood is the peak systolic pressure
Diagnostic Prosedures and Analysis
A: Fusiform infrarenal aortic aneurysm. B: Tortuous elongated aortic aneurysm with the sac
shifted to the left of the midline. C: Saccular aortic aneurysm. D: Infrarenal aortic aneurysm
extending into the iliac arteries. E. Suprarenal aortic aneurysm involving the renal arteries. F:
Dissecting aortic aneurysm with a tear between the intima and media allowing blood into the
subintimal space. G: Dissecting aortic aneurysm in which the intima or media has fully dissected,
creating a false flow lumen. H: Double aneurysm of the aorta producing a ‘dumb-bell
appearance’. I: False aneurysm of the common femoral artery following arterial puncture. (TL,
true lumen; FL, false lumen.)