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[血管外科]Peripheral Arterial Occlusive Disease

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中文字幕 小西悠 迅雷[hr]
Peripheral
Arterial Occlusive Disease

Acute PAOD:
1. Etiology - Embolus (majority), thrombus,
or trauma
2. 症狀 - 6Ps (pain, paralysis,
paresthesia, pallor, pulselessness, poikilothermy)
3. Thrombosis vs. Embolism




Thrombosis


Embolism




Previous claudication


No previous symptoms of arterial insufficiency (無足夠時間形成側枝循環)




No source of emboli


Obvious sources of emboli(AF、MI)




Long history


Sudden onset




Less severe ischemia控件軟體


Severe ischemia




Lack of pulses in the contralateral leg


Normal pulses in the contralateral leg




Positive signs of chronic ischemia


No signs of chronic ischemia




4.diagnosis- history+PE, arteriography

-many patient have coexistent cardiac disease: ECG, CXR, and TEE
5.management-heparin(administered immediately)
- 早發現 (數小時內) - thrombolytic therapy

- 晚發現 (>一天) - surgical embolectomy
6.complication-reperfusion injury,
rhabdomyolysis, compartment syndrome
Chronic PAOD:
1.Etiology - Atherosclerosis (majority)
2.diagnosis- lower-extremity symptoms:
pulses, bruits, ulcers甲尚

-ABI:normal>1.0, claudication<0.8, rest pain and severe
ischemia<0.4

-digital subtraction arteriography (gold standard)
ulcer classification:
A
V
Neuropathy :Skin calloused, No
pain, Usually no gangrene, Decreased sensation, abscent
ankle jerks

3.Classification:
Fontaine Classification:
Stage 1 - Numbness
(Asymptomatic)
Stage 2 -
Intermittent claudication
Stage 3 - Ischemic rest pain
Stage 4 -
Ulceration or gangrene
Dry gangrene:預後較好,會auto-amputation
Wet
gangrene:預後較差,會infection,要用抗生素
3及4的症狀又稱為肢體危急性缺血症狀(critical limb ischemia)此時需要手術介入

4.management - physical : 睡覺時把腳放低於心臟的位置, 多運動
- Medication: lipid reduction,
antihypertensives, aspirin, and antiplatelet drug

- Surgical : stenting, amputation

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作者: oehrvqgd
  (2012-03-12 01:35)
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