周圍血管疾病7PeripheralVascularDiseases周圍血管疾病周圍血管疾病7ThromboangitisObliterans（Buerger‘sDisease）ETIOLOGYExternal---cigarettesmoking，frigidirritation，injury，infection，sexualhormone，etcInternal---hereditarysusceptibility，autoimmunedisease，highcoagulationstatusofblood，etc周圍血管疾病7PATHOLOGY

（1）invadingmiddleandsmallarteriesandveins，commononlowerlimb

（2）artery---sclerosis，stricture，occlusion（segmentaldistribution）（3）perivascularinflammation—infiltrationofinflammatorycells，proliferation，fibrosis，etc

（4）changesofveins---inflammation，thrombosis，fibrosis，etc

周圍血管疾病7CLINICALPRESENTATIONmainlyincluding(1)tiredness,intermittentclaudication;(2)pain,numbness,silent(rest)pain;(3)migratorysupperficialthrombo-phlebitis;(4)decreaseorlossofarterialpulse;(5)ischemicarterialulcer,dry&wetgangrene.

周圍血管疾病7Threestagesaredividedaccordingtotheextentofarterialischemia&diseasestatus(naturalhistory):

1ststage:LocalIschemia—functionalspasm&strictureofartery.

2ndstage:NutritionalDysfunction—severestricture&occlusionofartery.

3rdstage:Necrosis&Gangrene—completeocclusionofartery.周圍血管疾病7DIAGNOSIS

history+symptoms&signs+specialexam:Buerger’stestDopplerultrasoundAngiography(DSA)MRA周圍血管疾病7DIFFERENTIALDIAGNOSISatherosclerosisobliteration(ASO,動脈硬化閉塞癥）

acutearterialembolism（急性動脈栓塞）

multiplearteritis（多發性大動脈炎）

diabeticfoot（糖尿病足，糖尿病性壞疽）

Raynaud’ssyndrome（雷諾綜合征）周圍血管疾病7動脈硬化性閉塞癥血栓閉塞性脈管炎發病年齡多見于45歲以上青壯年多見血栓性靜脈炎無常見高血壓、冠心病、高脂血癥、糖尿病常見常無受累血管大、中動脈中、小動靜脈其他部位動脈病變常見無受累動脈鈣化可見無動脈造影廣泛性不規則狹窄和節段性閉塞，硬化動脈擴張、扭曲節段性閉塞，病變近、遠側血管壁光滑周圍血管疾病7TREATMENTNonsurgicaltherapy

cessationofcigarettesmokingfunctionalexercisesvasodilators&analgetics

anticoagulantshigh-pressureoxygentherapyChinesemedicine周圍血管疾病7SurgicaltherapylumbarsympathectomyPTA(percutaneoustransluminalangioplasty)arterialbypassproceduresarteiovenostomyamputation

周圍血管疾病7

VenousDiseasesofLowerExtremityINTRODUCTIONGeneraldivision:reflux,occlusiveClassificationDiagnosis周圍血管疾病7SimpleVaricesofLowerExtremity

greatsaphenousvarices1.ETIOLOGYcongenitalvenousabnormalityhighvenouspressure

周圍血管疾病72.PATHOLOGYvenousvalveatrophyorloss→refluxofvenousbloodandsludgingofblood→skinpigemntation,anoxemiaoflocaltissue→dermatitis,erosion,ulcer,etc3.PRESENTATIONmainlymanifestation—superficialvenoustwistsandturns,segmentaldilitation.dermatitis,erosion,ulcer

周圍血管疾病74.DIAGNOSISclinicalpresentations+adjuvantexam.Trendelenburg’stestPerthes’testPratt’stestAngiography(venous)DifferentialDiagnosis周圍血管疾病7TREATMENTNonsurgicaltherapyavoidstandingforalongtimewearelasticstockingssclerosingtherapydrugsSurgicaltherapyligating&strippingthegreator/andlessersaphenousvein&itsbranches

周圍血管疾病7PrimaryIncompetenceofDeepVenousValveofLowerLimbsDEFINITIONCLINICALPRESENTATIONsimilartosimplevenousvaricesoflowerextremity,butthesymptomsaremoresevereDIAGNOSISdopplerultrasonogrphyphotoelectricplethysmographyvenousangiography(antegrade&retrograde)

周圍血