ZAPOROZHYE STATE MEDICAL UNIVERSITY CHAIR OF HOSPITAL SURGERY ASSISTANT PROFESSOR KLYMENKO A.V.

LOWER EXTREMITY PERIPHERAL ARTERIAL DISEASE (LEPAD)

1 , 5 2003 .

LEPAD
Atherosclerosis Buerger

Disease (Thromboangiitis Obliterans) Takayasu Arteritis (Non-specific

aortoarteritis)
Combinations

Classification of cronic ischaemia by Fonthen - Pokrovskiy

I

degree: asymptomic ischaemia of tension parastesia, numbness, extremity coldness II degree: intermittent claudication more than 200 m of walking less than 200 m of walking III degree: rest pain, night pain. IV degree: necrotic changes necrosis, gangrene, ulcer.

Occlusion\stenosis level
Aortal-ileal segment aorta lower than renal arteries till external ileac artery at inguinal ligament. Femoral-popliteal segment common, superficial and profunda arteries, popliteal artery till its threefurcation. Periferal (distal) segment shin arteries ( anterior and posterior thibial arteries).
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Points for auscultation of the arteries

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Normal angiography

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Aortal-ileal segment

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Femoral-popliteal segment

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Periferal (distal) segment

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BACKGROUND
Atherosclerosis is the leading cause of occlusive arterial disease of the lower extremities Atherosclerosis is also a leading cause of death and disability in the developed world Atherosclerotic lesions affect large and medium-sized arteries
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PATHOPHYSIOLOGY STAGES 1) a fatty streak 2) a fibrous plaque 3) a complicated lesion

ATHEROTHROMBOSIS

a fibrous plaque

rupture

Developping The thromb of the thromb encloused into atheroma

Emboli

Stable plaque

Occlusion

Chronic ischaemia

Acute ischaemia

THEORIES
Hypercholesterinaemia Dislipidaemia Infective Macrofagal Lipid

peroxide Traumatic

RISK FACTORS
Hyperlipidaemia Tobaco smocking Fat body Hypodynamia Stress Diabetis melitus Hypertony Age more then 45

FREQUENCY
In

the US: on the basis of ancle-brachial blood pressure ratios, the prevalence of LEPAD is approximately 3% in people younger than 60 years. The prevalence increases to 20% in people older than 70 years.

Mortality \ Morbidity
The

mortality rate in patients with LEPAD is 6 times higher than that of age-matched control subjects, and it is almost exclusively the result of death due to myocardial infarction and stroke. The 10-year survival rate decreases from 80% to 55% in healthy individuals compared with patients with symptoms of LEPAD

RACE
No

racial predilection exists for the development of LEPAD

SEX
Males

and females have an equal risk of LEPAD; however, atherosclerosis of the lower extremities is seen most frequently in elderly men.

AGE
The

highest incidence occurs in those aged 50-70 years

Preferred examination
Ankle-brachial

index Plethysmography
Doppler

ultrasonography

Conventional

arteriography Computed tomography angiography and magnetic resonance angiography

Doppler ultrasonography

Stenosis of the profundal femoral artery

Doppler ultrasonography.

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Conventional arteriography

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Conventional arteriography

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Occlusion of the trifurcation of the popliteal artery

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Occlusion of the thibial arteries

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CLINICALY
IV degree III degree

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MEDICINES
Spasmolytics: papaverin, No-spa, nicotin acid

Hypolipidaemic: lovostatin, liprimar

Enelbin
Decreasing of thrombotic activity: heparin, fractioned heparin, sincumar

Metabolics improoving oxidation: solcoseryl , actovegin Metabolics: vit. E, vit A, esenciale

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Antiagregants: aspirin, trental, ticlid, ipaton

ACTION OF ANTITHROMBOSITICS

AORTABIFEMORAL SHUNTING

PROSTHESIS

AORTA

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Reimplantation of the inf. mesenteric artery into the prosthesis inf. mesenteric artery prosthesis

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After the ABSh

Endarterectomy out of the femoral artery

Endarterectomy plus autovenous profundoplasty

Femoral-popliteal shunting with artificial graft

Femoral-popliteal autovenous shunting

Femoral-popliteal autovenous shunting

Balloon angioplasty plus stenting before after

Buerger Disease (Thromboangiitis Obliterans)

Rare Distal

segment in 70% It can be in remission and exacerbation Stages: - prodromal - angiospastic - angiotrofic - gangreenous

Buerger Disease (Thromboangiitis Obliterans)

It begins at allergic reaction with primery or secondary angiospasm, which makes hypoxia and blood flow decreasing. After that there will be immune inflamation with endotelial proliferation fand thrombosis. Medicamental treatment is preferable. In case of complication you may use sympatectomy and amputations.