Arterial, Venous

& L ymp hatic

Diso rd ers

BY
Dr. Tehreem Nasir
MBBS, RMP
Diseases of Arterial system
• Acute arterial occlusion
• Chronic arterial occlusion
• Buerger’s disease
• Aneurysms
• Vasospastic diseases
• Gangrene, Pregangrene, Amputation
• Thoracic Outlet syndrome
• AV fistulas
Arterial Occlusion
May be caused by:
• Intrinsic factors
• Embolus
• Thrombus
• Extrinsic Factors
• Trauma
Types of • Chronic Arterial Occlusion may be of
four types:
Arterial • Intermittent claudication

Occlusion
• Ischemic pain on walking
• Rest pain
Arterial occlusion may be of two types: • Ischemic pain on rest
• Acute Arterial Occlusion:
• Ischemic skin changes
• Occlusion of arteries for less than 2
weeks
• Skin discoloration due to prolonged
• Chronic Arterial Occlusion: ischemia
• Arterial occlusion for more than 2 weeks
• Gangrene
• Blackish discoloration of area due
to necrosis
 Management of acute
arterial occlusion

• Medical:
• Heparinization
• Surgical:
• Embolectomy
Management of
Chronic Arterial Management
Occlusion

Non-Surgical Surgical

Risk Factor
Pharmacological Minimally invasive Invasive
modification

Stop smoking; Control Ca Channel Blockers;

Endarterectomy;
HTN, DM, Obesity and Nitrates; Platelet
Balloon angioplasty Bypass, Amputation
hypercholesterolemia; aggregation inhibitors;
and stunting
Regular exercise Lipid lowering drugs
Venous
Disorders

• Superficial Venous Thrombosis

• Deep Venous Thrombosis
• Varicose Veins
 Superficial Venous Thrombosis
Superficial Venous Thrombosis is a type blood clot in a vein, which forms in a superficial
vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory
reaction around a thrombosed vein, presenting as a painful induration with redness.

Causes:
• Immobilization
Signs and symptoms:
• Hypercoagulable states • SVT is recognized by the presence of pain, warmth,
• Varicose Veins redness, and tenderness over a superficial vein.
• Intravenous catheterization • The SVT may present as a "cord-like" structure upon
palpation.
 Treatment
• Compression: Fixed compression bandages
• Physical activity
• Medications
• Anticoagulants
• NSAIDs (except aspirin)
• Antibiotics
• corticosteroids
• Surgical interventions:
• ligation and stripping of the affected veins,
and local thrombectomy.

Complications:
• Deep Venous Thrombosis
• Pulmonary Embolism
 Deep Venous Thrombosis
Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most
commonly the legs. The rate of DVTs increases from childhood to old age.

Symptoms
• pain, swelling, redness, or warmth of the affected area. About half of cases
have no symptoms.
Complications
• may include pulmonary embolism, as a result of detachment of a clot which
travels to the lungs, and post-thrombotic syndrome.
Risk factors
• Recent surgery
• Cancer
• Trauma
• Lack of movement
• Smoking
The underlying mechanism typically
involves some combination of decreased blood flow
rate, increased tendency to clot, and injury to the
blood vessel wall.
Diagnosis:
• D-dimer
• ultrasound of the suspected
veins
Treatment:
Anticoagulation (blood thinners) is the standard treatment.
• low-molecular-weight heparin
• Warfarin
• direct oral anticoagulant
Prevention
Preventive efforts following surgery may include early and
frequent walking, calf exercises, aspirin, anticoagulants,
graduated compression stockings, or intermittent pneumatic
compression.
 Varicose Veins
Varicose veins are superficial veins that have become
enlarged and twisted.
Cause/Risk Factors
Signs and symptoms • More common in
The superficial veins of affected legs become
women than in men
painful, tortuous and thickened. Later on, they
• Prolonged standing
develop skin discoloration, and ulcer
• Pregnancy
formation.
Underlying mechanism • Menopause

weak or damaged valves in the veins. • Aging

• DVT
Diagnosis
• Surgery
• Examination
• Abdominal straining.
• Ultrasound
 Treatment
• Drug therapy for varicose vein
symptoms
• For the relief of pain and
inflammation
• Compression hosiery/Stockings
• Sclerotherapy
• Surgery
• Stripping and ligation of superficial
veins
Physiotherapy
 Lymphatic
Disorders
The lymphatic system functions as a critical portion of
the body's immune system and returns interstitial
fluid to the bloodstream.
 Lymphedema is a
condition of localized
fluid retention and
tissue swelling caused
by a compromised
lymphatic system.
 Lymphadenitis:

It is enlargement in one or more lymph nodes

usually due to infection.
Test:
Types:  Blood test to look for infection

• 1. Localized lymphadenitis  Taking a sample of tissue from the lymph node or fluid from inside the
lymph node to study under microscope.
• 2. Generalized lymphadenitis  Placing fluid from the lymph node into a culture to see what type of germs
grow
Symptoms: Treatment:

• Nodes that increase in size  Antibiotics given per oral or IV

 Control of pain and fever
• Nodes that are painful  Surgery to drain/remove infected lymph node
• Nodes that are soft or matted together
• Redness or red streaking of the skin over nodes
• Nodes that are filled with pus
 Signs and symptoms:
• The most common manifestation of lymphedema is soft tissue
swelling, edema.
• As the disorder progresses, worsening edema and skin changes
including discoloration, verrucous (wart-like) hyperplasia,
hyperkeratosis, and ulcers may be seen.
• Additionally, there is increased risk of infection of the superficial soft
tissues, known as cellulitis.

Complications:
• Poor wound healing
• Infections: cellulitis, lymphangitis, lymphadenitis
• Skin ulcers.
• In rare cases, lymphedema can lead to a form of cancer called lymphangiosarcoma
.
 Causes:
• Inherited (primary)
• Injury to the lymphatic vessels (secondary)
• It is most frequently seen after lymph node dissection,
surgery and/or radiation therapy, in which damage to
the lymphatic system is caused
• Certain diseases or problems that may inhibit the
lymphatic system from functioning properly.
• In tropical areas of the world, a common cause of
secondary lymphedema is filariasis, a parasitic
infection.
 Treatment:
• Combination of manual compression lymphatic massage,
compression garments or bandaging.
• Complex decongestive Physiotherapy is an empiric system of
lymphatic massage, skin care and compressive garments.
• Intermittent pneumatic compression therapy (IPC) promotes
movement of lymph fluid.
• Skin care
• Care should be taken when performing tasks with risks for cuts
and/or exposure to bacteria such as gardening, cooking, and
shaving.
• Surgical procedures
• Vascularized lymph node transfers (VLNT), Lymph nodes
are harvested from the groin area or the supraclavicular
area with their supporting artery and vein and moved to the
axilla or the wrist area.
• Lymphatic venous anastomosis (LVA) uses super-
microsurgery to connect the affected lymphatic channels
directly to tiny veins located nearby.
VASCULAR DISEASES AND
VASCULAR SURGERY
 INTRODUCTION AND DEFINITION

• Vascular disease (vasculopathies) affects the blood vessels that

carry oxygen and nutrients throughout your body and remove
waste from your tissues. Common vascular problems happen
because plaque (made of fat and cholesterol) slows down or
blocks blood flow inside your arteries or veins.
 Aneurysm
• An aneurysm is a bulging, weakened area in the wall of a blood vessel resulting in an
abnormal widening or ballooning greater than 50% of the vessel's normal diameter
(width). An aneurysm may occur in any blood vessel, but is most often seen in an
artery rather than a vein.
Causes of Aneurysm
• high blood pressure (hypertension) over many years resulting in damage and
weakening of blood vessels. fatty plaques (atherosclerosis) resulting in a weakness of
the blood vessel wall. inherited diseases that may result in weaker than normal blood
vessel walls.
• TREATMENT
• Aneurysm repair:
• Carotid endarterectomy:
• Revascularization and bypass graft surgery:
• Thoracic outlet repair:
 Buerger’s disease (thromboangiitis obliterans)
• It is a rare disease of the blood vessels in arms, legs, fingers and toes. Inflammation in
the blood vessels makes it hard for blood to flow through them. Blood clots can form,
which create obstacles inside the blood vessels.
Causes
• The cause of Buerger’s disease is not known, but scientists think something in tobacco
hurts the lining in your blood vessels. Most people with Buerger’s disease are tobacco
users.
Symptoms
• Hand or foot pain (burning or tingling feeling).Sores on toes or fingers. Skin color or
texture change.
Treatment
• Vascular Surgery
• Distal limb amputation for nonhealing ulcers, gangrene.
Raynaud disease & Syndrome
Diagnostic evaluation :
• History collection and physical
Definition :
examination
• Disorder affecting blood vessels
of fingers and toes which become • Blood studies ( ESR level rise )
abnormally constricted . • Cold stimulation test
• It causes decreased blood flow to Management :
fingers and toes. • Life style modifications (avoid
• Sign and symptoms : smoking and caffine, regular exercise
• Numbness , sensation of cold , ,control stress and take care of hands
burning pain , Parasthesia, colour and feet )
changes of one or more digits , • Medical management ( alcium
pain , skin ulcer , gangrene , pallor channel blockers , vasodialators and
and swelling alpha blockers )
Surgical treatment :
Nerve surgery
 Introduction to Vascular Surgery

• Surgery on vessels to regulate obstructed/compromised

blood flow
• surgery is a surgical subspecialty in which vascular diseases
involving the arteries, veins, or lymphatic vessels, are
managed by medical therapy, minimally-invasive catheter
procedures and surgical reconstruction
 Indications of Vascular Surgery

• Abdominal aortic aneurysm leading to death.

• Carotid artery disease leading to stroke.
• Peripheral arterial disease leading to amputation.
 Complications of Vascular Surgery

Complications of peripheral venous access

• Bleeding Complications of arterial access
• Thrombophlebitis • Bleeding.
• Hematoma • Aneurysm
Complications of central venous access • Injury to adjacent structures.
• Blood stream infection • Arterial Thrombosis
• Injury to adjacent structure. • Hematoma
• Veinous perforation • Cellulitis
•
THANK YOU