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Embolic occlusion An embolus is an object that has become lodged in a vessel and causes obstruction, having been carried in the bloodstream from another site. It is often a thrombus that has become detached from the heart or a more proximal vessel. Sources inc...

FURTHER READING Bhattacharya V , Stansby G (eds). Postgraduate vascular surgery: a candidate’s guide to the FRCS and Board Exams . Singapore: World Scientific Europe Ltd, 2018. Moore WS (ed.). Vascular and endovascular surgery: a comprehensive review , 9th edn....

Features of chronic arterial stenosis or occlusion in the leg Intermittent claudication Intermittent claudication occurs as a result of anaerobic muscle metabolism and is classically described as debilitating cramp-like pain felt in the muscles that is: /uni2...

Femoral aneurysm True aneurysm of the femoral artery is uncommon. Complications occur in less than 3% so conservative treatment is generally indicated, but it is important to look for aneurysms elsewhere as over half are associated with abdominal or poplitea...

GANGRENE Gangrene refers to the death of macroscopic portions of tissue, which turns black because of the breakdown of haemoglobin and the formation of iron sulphide. It usually a ff ects the most distal part of a limb because of arterial obstruction (fr...

Iliac aneurysm This usually occurs in conjunction with aortic aneurysm and only rarely on its own. When occurring in isolation it is di ffi cult to diagnose clinically so about half present already ruptured. Open surgery usually involves an inlay graft but some ...

CH A P TER INTRODUCTION Arterial disorders represent the most common cause of morbidity and early death in western societies. Much of this is as a result of atheromatous plaque build-up causing steno ses (atherosclerosis) within the arteries that supply the ...

Investigation of arterial occlusive disease Most patients with symptomatic lower limb ischaemia pres ent with mild symptomatology and do not require invasive treatment, such as angioplasty or surgical reconstruction, and the decision of whether or not to inte...

Learning objectives To understand: The nature and associated features of occlusive peripheral • arterial disease The investigation and treatment options for occlusive • peripheral arterial disease The principles of management of the severely ischaemic • limb

Major amputation Choice of operation The major choice is between an above- and below-knee operation. A below-knee amputation preserves the knee joint and gives the best chance of walking again with a prosthesis ( Figure 61.37 ). However, an above-knee amputat...

Management of arterial stenosis or occlusion General Only one-quarter of patients presenting with intermittent claudication will experience symptomatic deterioration during their lifetime and the overall risk of progression to CLTI and amputation is small, w...

Miscellaneous Other types of gangrene commonly encountered include bedsores and frostbite. Bedsores are gangrene caused by local pressure ( Figure 61.27 ), whereas frostbite is caused by exposure to cold ( Figure 61.28 ). Both are preventable with adequate pr...

Operations for arterial stenosis or occlusion Site of disease and type of operation Surgical operations are usually reserved for patients with severe symptoms (CLTI or lifestyle-limiting claudication) where angioplasty has failed or is not possible. Aortoiliac...

Other forms of arteritis Arteritis occurs in association with many connective tissue disorders, e.g. rheumatoid arthritis, systemic lupus erythema tosus and polyarteritis nodosa. Temporal arteritis is a disease in which localised infiltration with inflammatory a...

Other forms of embolism Infective emboli of bacteria or an infected clot may cause mycotic aneurysms, septicaemia or infected infarcts. Parasitic emboli, caused by the ova of T aenia echinococcus and sanguinis hominis , may occur in some countries. Tumour cel...

PERIPHERAL ANEURYSM Popliteal aneurysm Popliteal artery aneurysm accounts for 70% of all peripheral aneurysms classically diagnosed in men in their seventh decade of life; 50% are bilateral. Examination of the abdominal aorta is indicated if a popliteal an...

Raynaud’s disease This idiopathic condition usually occurs in young women and a ff ects the hands more than the feet. There is abnormal sensi tivity in the arteriolar response to cold. These vessels constrict and the digits (usually the fingers) turn white and b...

Raynaud’s syndrome Raynaud’s syndrome is the peripheral arterial manifestation of a collagen disease such as systemic lupus erythematosus or - rheumatoid arthritis. The clinical features are as for Raynaud’s disease but they may be much more aggressive. Rayna...