ANEURYSMS &

GANGRENE.
DEFINITION.
 Dilatation of localized segment of arterial
system when the diameter is more than 50 %.
Below 50% is called ECTASIA,.

 Can be of 2 types .
 TRUE.Aneurysm. Involving 3 layers of vessel.
 FALSE Aneurysm. Occurs due to trauma.
Involving single layer of fibrous tissue in the
wall of the sac.
 CLASSIFICATION OF ANEURYSM.
 ACCORDING TO SHAPE.
 Fusiform.
 Saccular.
 According to Morphology.
 TRUE.
 FALSE.
 ACCORDING TO PATHOLOGY.
 Atheromatous.
 Mycotic.
 Collagen disease.
 Trauma.
COMMON SITES OF ANEURYSM.
 AORTIC ANEURYSM.
 CEREBRAL ANEURYSM.
 PERIPHRAL ANEURYSM.
 Popliteal aneurysm.
 Splenic artery aneurysm.
 Mesenteric artery aneurysm.
 Femoral artery aneurysm.
 Visceral artery aneurysm.
CLINICAL PRESENTATION.
 Asymptomatic.
 Twice the size of the vessel increases the
risk of complication.
 Compression of surrounding structures.
 Thrombosis, Rupture, Release of emboli.
 On examination aneurysm is palpable with
expansile impulse.
ABDOMINAL AORTIC
ANEURYSM.
 Ocurs in 2% of population.
 95% are due to atheromatous degeneration.
 95% ocurs below renal artery.
 Mostly assymtomatic.
 Rupture ocurs due to increase in diameter.
 Back pain and abdominal discomfort.
 Severe abdominal pain.
 Erosion or compression of surrounding
structures with enteric fistula , ureteric
obstruction.
AORTIC ANEURYSM
INVESTIGATIONS.
 CBC.
 Electrolytes.
 LFTS.
 Coagulation profile.
 Lipid profile.
 ECG ,chest X ray.
 Echocardiography, Spirometry.
 CT scan abdomen.
 Duplex scan in cases of absent pulses.
 DSA scans, Angioplasty.
TREATMENT OPTIONS.
 IN assymptomatic patients. The repair can
be done if the size is more than 55mm. By
ultrasound. Rupture ocurs at 70mm.
 SUGICAL OPTIONS.
 Open surgery with synthetic or stent graft.
 Endovascular stent graft surgery.
 Stent graft prosthesis is of 2 types.
 Dacron.
 PTFE.
RUPTURED AORTIC ANEURYSM.
 Anterior rupture in peritoneal cavity. 20%,
 Posterior rupture in retroperitonal space.
80%,
 Less than 50% reach hospital.
 Haemorrhage {anterior rupture.}.
 Retroperitonal haemorrhage {posterior
rupture.}.
 Mortality rate 80-90%.
SURGICAL EMERGENCY
SUSPECTED.
 Severe abdominal pain.
 Back pain, hypotension.
 Pulsatile abdominal mass.
 CT scan findings.
 IV acsess , fluids.
 Patient should be shifted to OT. With foleys .
 Blood should be arranged.
 Open repair with graft. Insertion.
POSTOPERATIVE
COMPLICATION.
 Ischemia, Infarction.
 Respiratory atelactasis.
 Colonic ischemia.
 Renal failure.
 Sexual dysfunction.
 Spinal cord Ischemia.
 Aortoduodenal fistula.
 Prosthetic graft infection.
 Endoleak, graft migration, metal stent
fracture.
POPLITEAL ANEURYSM
 Common in 70% of periphral aneurysm.
 Ocurs in males in 7th decades of life.
 50% bilateral.
 Associated with aortic aneurysm.
 Swelling behind the knee.
 Assymptomatic aneurysm more than 20 mm
considered for elective repair.
 Exclusion bypass, inlay repair.
GANGRENE DEFINITION.
 Death of the macroscopic portion of the
tissue which turns black due to breakdown of
Hb and formation of iron sulphide.
 Mostly affects the distal part of the limb as
a result of thrombosis, embolism or
arteritis.
 A zone of demarcation between the viable
and the dead tissue will appear.
CAUSES OF GANGRENE.
 LACK OF BLOOD SUPPLY.
 INFECTION.
 TRAUMA.
TYPES OF GANGRENE.
 DRY GANGRENE.
 Develop slowly, ocurs in atherosclerosis,
diabetes.
 WET GANGRENE.
 Develop after severe burn, frost bite, injury.
 Spreads quickly and can be fatal.

 GAS GANGRENE.
 Caused by clostridium perferinges,
 Develops after injury or after surgery.
 Can be life threatening.
 INTERNAL GANGRENE.
 FOURNIER”S GANGRENE.
 PROGRESSIVE BACTERIAL SYNERGESTIC
GANGRENE.{MELENEY”S GANGRENE.}
CLINICAL FEATURES.
 Skin discolouration.
 Swelling or blister formation.
 A line of demarcation.
 Severe pain followed by numbness.
 Foul smelling discharge.
 Thin shiny skin.
 Cool skin.
 Low grade fever.
 Septic shock.
RISK FACTORS.
 Diabetes.
 Atherosclerosis.
 Severe injury orsurgery.
 Smoking.
 Obesity.
 Immunosuppression.
 Drugs.
TREATMENT OPTIONS.
 Wound debridement.
 IV antibiotics.
 Distal amputation.
 Major limb amputation.
 INDICATIONS OF AMPUTATION.
 The limb is dead, deadly and deadloss.
 Wet gangrene.
 Spreading cellulitis.
 Malignancy. AV fistula.
 Severe rest pain. Paralysis.
Contractures ,trauma.
INDICATIONS OF AMPUTATION
DIABETIC GANGRENE.
 Caused by.
 Ischemia secondary to macrovascular disease,
and microvascular dysfunction.
 Sensorimotor neuropathy leads to trophic skin
changes and immunosuppression caused by
increased blood sugar promotes infection.
 Macrovascular disease affects crural vessels with
sparing of pedal vessels.
 Microvascular shunting causes microvascular
dysfunction, PSN. Causes.
 Increased risk of soft tissue injury,
 Joints of foot and ankle.
 Loss of nociceptive and proprioceptive reflexes.
 Repeated cycles of joint injury and bony destruction.
 Ischemia PSN causes diabetic ulceration with
decreased healing potential.
 Superaded infection leads to fulminant foot sepsis,
gangrene, and death.
 TREATMENT.
 Depends on the degree of arterial involvement,
 Investigation, angioplasty and surgery.
 I/D of abcess, debridement of dead tissues, antibiotics.
 Primary amputation. In cases of sepsis and shock.
DIABETIC GANGRENE.
PRESSURE SORES
 Gangrene caused by local
pressure. Due to 5 factors.
 Pressure.
 Injury.
 Anemia.
 Malnutrition
 Moisture.
 Ocurs in bed bound patients with
debilitating illness.
PREVENTION & TREATMENT.
 Avoidance of pressure foam block.
 Change of posture.
 Waterbed or ripple bed.
 Nursing and dressing.
 Wound debridement,
 Vaccum dressing,
 Plastic surgery for rotation flaps.
FROST BITE.
 Exposure to cold.
 Cold injury damages the blood vessel wall
causing swelling, leakage of fluid and pain.
 Waxy appearance, blistering, and gangrne
follows.
 Treatment includes.
 Rewarming,
 Analgesia.
 Delayed conservative amputation.
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