AGGRAVATING FACTORS

Propagation of thrombus.
Fragmentation of the embolus
Venous thrombosis.
Arteritis and Vasospastic Disease
VASOSPASM.
.Usually occurs in isolation, most often affecting the
digits (Raynauds disease) but can also affect other
extremities (nose, ear, tongue)
.Can be associated with other conditions- Raynauds
syndrome:
Connective tissue diseases
Occlusive arterial disease
Pharmacological (beta-blockers, ergotamine)
Occupational (vibration white finger)
.Episodic blancing of extremity, typically followed by
cyanosis then reactive hyperaemia
.Prolonged vasospasm may result in digital arterial
thrombosis and painful ulceration /infarction.
Diagnosis
Diagnosis is primarily clinical
Detection of associated conditions (ESR,
CRP, thyroid function, autoantibodies)
Cold challenge-attempt to induce
vasospasm
Digital blood pressure pre-post-cold
challenge
Management
Avoidance of risk factors/triggers (cold,
drugs, smoking)
Vasodilator therapy (ca-channel blockers,
prostacyclins)
Sympathectomy (most useful in treating
painful digital infarcts)
Arteritis
A feature of group of conditions known as the
vasculitides
Characterised by an inflammatory process
affecting the vessel wall.
Resulting in obliterative thrombosis.
Process may affect vessels of different calibre.
Aorta and mayor vessels (Takayasus dis)
Large/medium sized vessels (Buergers dis)
Medium vessels (Polyarteritis nodosa; Wegners
granulomatosis)
Small vessels (Rheumatoid arthritis/ vasculitis)
Clinical Features
Non-specific symptoms of systemic
inflamatory disease.
Associated rheumatological symptoms
(arthralgia; myalgia; Raynauds)
Asymmetry of pulses (Takayasus)
Critical limb ischemia/ gangrene
(Buergers)
Ulceration (small vessel disease)
Treatment
Immunosuppresion: Corticosteroids.
Prostacyclin
Cyclophosphamides.

Surgery: Sympathectomy
Amputation.
To bypass large vessel occlusions
(Takayasus)