Arterial Disorders

Arterial Stenosis and Occlusion.
Aetiology:
               1.Atheroma(commonest)
               2.emboli
               3.trauma
2. & 3. in acute form.

Signs and Symptoms:
                              -are related to the organs supplied by the affected artery.
-Lower limbs
                   -claudication, rest pain and gangrene.
-Brain
                   -TIA(transient ischaemic attack)
-Myocardium
                   -Angina amd MI.
-Kidney
                  -hypertension and
renal artery
-Intestine
                  -abdominal pain and infarction


Features of arterial stenosis or occlusion in the leg:


 1.Intermittent claudication
 2.Rest pain
 3.Cold, numb, paraesthesia, colour change
 4.Ulceration
 5.Gangrene
 6.Assumes ambient temperature
 7.Sensation decreased
 8.Movement diminished or lost
 9.Arterial pulsation diminished or absent
 10.Arterial bruit
 11.Slow venous refilling

*Relationship of clinical findings to site of disease is very important.

Investigation of arterial occlusive disease:
-Most patients do not need active treatment, such as angioplasty or surgical reconstruction.

General investigation-

-if active intervention is contemplated full assessment is essential.
-Tests relevant to diabetes, abnormal lipid metabolism, anaemia etc
-Cardiac failure, myocardial ischaemia, hypertension and age related diseases such as chronic obstructive pulmonary disease and neoplasia should also be considered.

Doppler ultrasound blood flow detection-
                           -most useful in the assessment of occlusive arterial disease.
                           -determines systolic pressure and blood flow in the artery.
Duplex imaging-
                          -provide an image of vessels


Treadmill-
                         -Patients themselves are poor at assessing claudicating distance.
                         -provide a useful objective measurement of distance to onset of pain.

Angiography (synonym: arteriography)-
                        1.classical retrograde percutaneous catheter method (Seldinger technique):
                                                                -problems:thrombosis, arterial dissection, haematoma, renal dysfunction and allergic reaction
                                                                -with less contrast agent( radio-opaque solution) injected via femoral artery.
                        2.digital subtraction angiography (DSA)
                                                                 -higher clarity though with large contrast agent.
                                                                 -i.v/arterial injection of solution.
                        3.CT angiography:
                                                                -gaining popularity.

Management.

Non-surgical:
                    (1.)General: 
                                   -Spontaneous improvement occurs over the first 6 months after an occlusive episode as collateral vessels develop
                                   -Exercise is encouraged(within the limits of their disability)
                                   -dietary advice
                                   -stop smoking
                                   -other lifestyle advice.
                     (2.)