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Home , Arteriosclerosis

Peripheral • Disease of • Disease of – Arteriosclerosis(동맥 – Superficial venous 경화) (,t – Athrosclerosis(죽상동 hrombophlebitis)(천 맥경화) 부 정맥성 혈전증) – ( 동맥류) – Deep vein – thromboangiitis thrombosis(심부 정맥 obliterans(폐쇄성혈전 혈전증) 혈관염)=Buerger` dz – Pulmonary – Raynaud`s disease (폐동맥성 혈 전증) – Varicose vein(정맥류) anatomy

• Arteries – Three layer • Tunica externa(adventitia) : outer layer, mainly fibrous tissue – prevent overdistention • Tunica media : smooth muscle and elastic tissue – control lumen • Tunica interna(intima) : epithelial cell – help to prevent clotting • Vein – Similar to the arteries structure – But less muscle and elastic tissue – Tunica media is thin – Vein has valves : allowing the blood to flow one direction toward heart

Venous return Disease of arteries - arteriosclerosis • Degenerative changes begin in the tunica media of medium sized arteries: destruction of muscle and elastic tissue – replaced fibrous tissue • Later affect tunica interna • Calcium deposited • So loss of elasticity – it lead to increased peripheral resistance and raised Disease of arteries - athrosclerosis • Most common occlusive arterial disease • Deposited abnormal lipid material in the tunica interna layer • Onset : 50 yrs • Male > female • Site : aorta, cerebral, renal, femoral, • causes : diet(high animal ), hyperlipidaemia, diabetes, smoking, , lack of Ex., • Athrosclerosis and arteriosclerosis may exist independently but frequently occur together Disease of arteries - athrosclerosis • Pathology – Lipid material is deposited on the tunica interna – Fibrin is laid down over the lipid material causing patches of raised area on the interna – Gradually increase in size – Underlying interna becomes softened and the areas becomes ulcerated – Ulceration leads to which spreads to the other arterial walls – Formation thrombus, lumen becomes occlued Disease of arteries - athrosclerosis • Clinical features – Coronary disease : angina pectoris, ischemic heart disease – Cerebral artery disease : ischemia of the brain – Iliac, femoral, popliteal artery • Intermittent : severe cramp – like pain, commonly calf muscle • Cold limb • Sensory change • Skin change : dryness, scaling, brittle nail, white and shiny skin • Loss of pulse • Rest pain(severe burning pain in the foot and toe at night) Disease of arteries - aneurysm • Dilatation of the wall of an artery forming a sac in communication with that vessel • Athrosclerosis : causes the aneurysm • Dissecting aneurysm : split in tunica media • Most common site : aorta, popliteal artery Disease of arteries - aneurysm • Clinical features – Asymptomatic • Treatment – operation Disease of arteries - thromboangiitis obliterans • Buerger`s disease • Unknown etiology • Cigarette smoking • Onset : 20~40 yrs male • Distal artery of lower limb, upper limb and visceral Disease of arteries - thromboangiitis obliterans • Pathology – Lympocyte invade artery wall – Wall becomes inflamed and clots – So obstruct the lumen of artery – Slowly progressive and extends to the collateral vessels • Symptoms – Mainly affected the leg – Rest pain – Cold in feet – Infection – Toe ischemia – Intermittent claudication – Ganrene : severe pain, prevent sleep Disease of arteries - thromboanginitis obliterans • Tx : Buerger`s Ex. to development collateral circulation in the leg – Lies supine : leg elevation 45° with supported until skin blanches about 2 min. – Sit up with the leg dependent until the skin color is blight red about 3 min. – Lies supine – leg horizontal until the skin color returns to normal about 5 min. – Repeat 4~5 times for 3 times daily. Disease of arteries - Raynaud`s disease • Vasomotor disorder : intermittent spasm of distal . • Occur women more than men, adolescence to middle age. • Primarily hand affected, unusually bilaterally. • Exposure to cold, emotion stress – aggravate symptom Disease of arteries - Raynaud`s disease • Pathology : spasm of the distal arterioles – reduce blood flow – skin white and num. permanent spasm : necrosis of finger or toe. • Clinical features – Intermittent attacked – Affecting both hands – Exposure cold : finger feel numb, appear white and shiny – Rewarming : become pink with burning sensation – Severe case : ulceration and atrophy of finger Disease of arteries - Raynaud`s disease • Tx. – active Ex. – improve circulation – Contrabath : hot bath-3 min, coolbath-1min – Massage and relaxation – Vsodilator drug • Advice – Avoid cold – Loose fitting gloves – Woolen socks, boots – Avoid immersed in cold water – Working in warm place – Stop smoking Disease of Venous - superficial () • Cause – Trauma to vessel wall • Drip needle • Pressure : tight garment, position – Circulating toxins from septic wound – Association with deep venous thrombosis • Pathology – Irritation – change in the tunica interna(inflammation) – Formation of thrombosis – Rarely produce an embolism Disease of Venous - superficial venous thrombosis(thrombophlebitis) • Clinical features – Localized, reddened – Warm area with hard – Swelling along the course of the vein – Pain may be present at rest and aggravated by movement of the limb • Treatment – Firm elastic bandaging or stocking from the toe – Drug – Leg elevation and foot exercise Disease of Venous - (DVT) • Definition : blocking of a deep vein by the formation of a thrombus – most commonly in the lower limb • Risk factors – Age : middle aged to elderly patient – Immobility, prolonged bed rest : venous stasis – Obesity – Congestive heart failure – Postoperative state – Increased coagulability of the blood – Injury to vessel wall : surgery or trauma – Previous history of DVT or people with vascular or blood disorder Disease of Venous - deep vein thrombosis(DVT) • Pathology – Platelets to be deposited on the vein wall – Venous stasis increase the accumulation of platelets – Increase thrombus size – Occlusion • Symptoms – Aching or cramp-like pain at site of thromus – Tenderness over the area – Edema – Positive Homan`s sign – May be symptomless Disease of Venous - deep vein thrombosis(DVT) • Management – Heparin – Acute deep vein thrombosis • Should remain bed with the foot elevated until all the local signs subside – may be 7 days • Foot and leg exercise • Encourage early ambulation with stocking • Prevention DVT – Elevation bed end(15~22cm) – Anti-embolic stocking – General breathing Ex. – Active movement(hip, knee, foot, ankle) – Early ambulation – Passive movement of a paralyed limb – Minimize risk factors – Anticoagulant therapy Disease of Venous - deep vein thrombosis(DVT) • Homan`s sign – Test for thrombosis – Test by dorsiflexing the patient foot – Positive if it produces pain in the calf

Disease of Venous - • Definition : thrombus break off in a deep vein – travels to the right side heart – enter the pulmonary artery – block a vessel • Clinical features – Large embolus • Sudden collapse • Severe retrosternal pain and shock • Dyspnea and distension of neck • Reduced air entry • treatment – Anticoagulants – Surgery – Bed rest with leg elevation Disease of Venous - varicose vein • Definition : dilated, lengthened and tortuous with incompetent valves • Etiology – Age : any age, but commonest : 40~50 yrs – Female > male • Predisposing factors – Compression of pelvic vein during pregnancy – Constant standing – Tight corset or garter – Heredity may be a factor – Secondary to DVT – Basic weakness of vein wall

Disease of Venous - varicose vein • Pathology – Vein wall dilates at weak area – Valves become incompetent • Complication – Bleeding following rupture of vein – due to devitalized skin – Superficial venous thrombosis – Edema, in particular of the foot and ankle • Management – Elastic support – Walking, avoid standing(1~2 mile a day) – Elevation of lower legs for 10 min, 3 times a day – Sleep with end of bed raised