周围血管疾病课件

周围血管疾病7PeripheralVascularDiseases周围血管疾病周围血管疾病7ThromboangitisObliterans（Buerger‘sDisease）ETIOLOGYExternal---cigarettesmoking，frigidirritation，injury，infection，sexualhormone，etcInternal---hereditarysusceptibility，autoimmunedisease，highcoagulationstatusofblood，etc周围血管疾病7PATHOLOGY

（1）invadingmiddleandsmallarteriesandveins，commononlowerlimb

（2）artery---sclerosis，stricture，occlusion（segmentaldistribution）（3）perivascularinflammation—infiltrationofinflammatorycells，proliferation，fibrosis，etc

（4）changesofveins---inflammation，thrombosis，fibrosis，etc

周围血管疾病7CLINICALPRESENTATIONmainlyincluding(1)tiredness,intermittentclaudication;(2)pain,numbness,silent(rest)pain;(3)migratorysupperficialthrombo-phlebitis;(4)decreaseorlossofarterialpulse;(5)ischemicarterialulcer,dry&wetgangrene.

周围血管疾病7Threestagesaredividedaccordingtotheextentofarterialischemia&diseasestatus(naturalhistory):

1ststage:LocalIschemia—functionalspasm&strictureofartery.

2ndstage:NutritionalDysfunction—severestricture&occlusionofartery.

3rdstage:Necrosis&Gangrene—completeocclusionofartery.周围血管疾病7DIAGNOSIS

history+symptoms&signs+specialexam:Buerger’stestDopplerultrasoundAngiography(DSA)MRA周围血管疾病7DIFFERENTIALDIAGNOSISatherosclerosisobliteration(ASO,动脉硬化闭塞症）

acutearterialembolism（急性动脉栓塞）

multiplearteritis（多发性大动脉炎）

diabeticfoot（糖尿病足，糖尿病性坏疽）

Raynaud’ssyndrome（雷诺综合征）周围血管疾病7动脉硬化性闭塞症血栓闭塞性脉管炎发病年龄多见于45岁以上青壮年多见血栓性静脉炎无常见高血压、冠心病、高脂血症、糖尿病常见常无受累血管大、中动脉中、小动静脉其他部位动脉病变常见无受累动脉钙化可见无动脉造影广泛性不规则狭窄和节段性闭塞，硬化动脉扩张、扭曲节段性闭塞，病变近、远侧血管壁光滑周围血管疾病7TREATMENTNonsurgicaltherapy

cessationofcigarettesmokingfunctionalexercisesvasodilators&analgetics

anticoagulantshigh-pressureoxygentherapyChinesemedicine周围血管疾病7SurgicaltherapylumbarsympathectomyPTA(percutaneoustransluminalangioplasty)arterialbypassproceduresarteiovenostomyamputation

周围血管疾病7

VenousDiseasesofLowerExtremityINTRODUCTIONGeneraldivision:reflux,occlusiveClassificationDiagnosis周围血管疾病7SimpleVaricesofLowerExtremity

greatsaphenousvarices1.ETIOLOGYcongenitalvenousabnormalityhighvenouspressure

周围血管疾病72.PATHOLOGYvenousvalveatrophyorloss→refluxofvenousbloodandsludgingofblood→skinpigemntation,anoxemiaoflocaltissue→dermatitis,erosion,ulcer,etc3.PRESENTATIONmainlymanifestation—superficialvenoustwistsandturns,segmentaldilitation.dermatitis,erosion,ulcer

周围血管疾病74.DIAGNOSISclinicalpresentations+adjuvantexam.Trendelenburg’stestPerthes’testPratt’stestAngiography(venous)DifferentialDiagnosis周围血管疾病7TREATMENTNonsurgicaltherapyavoidstandingforalongtimewearelasticstockingssclerosingtherapydrugsSurgicaltherapyligating&strippingthegreator/andlessersaphenousvein&itsbranches

周围血管疾病7PrimaryIncompetenceofDeepVenousValveofLowerLimbsDEFINITIONCLINICALPRESENTATIONsimilartosimplevenousvaricesoflowerextremity,butthesymptomsaremoresevereDIAGNOSISdopplerultrasonogrphyphotoelectricplethysmographyvenousangiography(antegrade&retrograde)

周围血