Disturbances of blood and lymph circulation in
lower extremities
J. Hanáček
Arterial disorders
USG examination of leg arteries
Stenosis of the proximal
left Iliac artery
Subclinical stenosis of leg artery
Hemodynamically important stenosis of leg artery
Analyze mechanisms of 6PS in subjects with chronic occlusive
arterial disease
Pain
Pale
Pulseless
Paresthesia
Paralysis
Perishing cold
Case report
- The patient is a 18 years old male, who, two months prior to medical consultation,
suffered an accidental wound in the middle third of the right thigh.
- A brief consultation is done in ambulatory conditions and a tumor is detected in the
middle third of the right thigh with a scar in its center.
- The formation is incised in ambulatory service and the incision resulted in serious
external hemorrhage. Provisional hemostasis is applied by digital pressure in the
incision zone; and the patient makes it to the surgical room! He is operated
immediately; the axis of the superficial femoral artery is explored and a parietal break
is detected (this was the source of the false aneurysm). The parietal breaking is sutured
with an enlarging patch and the tissues delimiting the false aneurysm are excised.
The evolution is good, uneventful, with no complications, the patient is discharged from
the hospital 10 days after the surgery.
A 19-year-old female college student had numbness and the sensation of coldness of her
left toes. She had a 3-year smoking history. Gangrene of the left foot developed rapidly.
Angiography revealed peripheral arterial occlusion of both legs and arms. Detailed
laboratory examination excluded collagen disease, a hypercoagulable state, and juvenile
atherosclerosis. Below-knee amputation of the left leg was performed. Typical histologic
findings of Buerger’s disease were observed in the crural arteries and saphenous veins.
The clinical course was uneventful after the patient stopped smoking. This is the second
case report of Buerger’s disease in a woman in the second decade of life. It is important
that a correct diagnosis of Buerger’s disease be established, because the disease process
is benign, compared with collagen disease, if the patient stops smoking.
48 years male, with DM type 1 (30 years duration),
hypertension, hyperuricaemia, and BMI 32 suffers from
intermittent claudicating, leg pain, and a wound (skin defect) on
the right leg resistant to treatment
Analyze how factors described below may contribute to occlusive
arterial disease
- Diabetes mellitus
- Hyperglycaemia
- Hypertension
- Hyperuricaemia
- BMI 32
How this situation can be promoted by microangiopathy and
neuropathy?
Is age 48 typical for having advanced occlusive arterial disease?
Explain.
Ischemic ulcer
Venous disorders
Deep venous trombosis
Risk factors - acquired
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Older age
Major surgery and orthopedic surgery[19]
Cancers, especially of the bone, ovary, brain, pancreas, and lymphomas[12]
Inactivity and immobilization, as with orthopedic casts,[19] sitting, travel, bed
rest, and hospitalization[8]
Pregnancy and the postpartum period[8][22]
Antiphospholipid syndrome[23]
Trauma,[8] minor leg injury,[16] and lower limb amputation[12]
Previous VTE[24]
Combined oral contraceptives[12]
Hormonal replacement therapy[19]
Central venous catheters[25]
Inflammatory diseases[10][26]/some autoimmune diseases[27]
Nephrotic syndrome[11]
Obesity[19]
Infection[11][26]
HIV[11]
Polycythemia vera[19]
Chemotherapy[9]
Intravenous drug use[28][29]
Inherited
Antithrombin deficiency[8]
Protein C deficiency[8]
Protein S deficiency (type I)[11]
Factor V Leiden[e]
Prothrombin G20210A
Dysfibrinogenemia[19]
Non-O blood type
Mixed
Low free protein S[11]
Activated protein C resistance[11]
High factor VIII levels[31]
Hyperhomocysteinemia[8]
High fibrinogen levels[8]
High factor IX levels[8]
High factor XI levels[8]
Rudolf Virchow
Deep venous trombosis
Pitting edema
Case report
70 yr old female is complaining about leg pain, mainly after exercise, not during
it, she describes her feeling as heavy legs, especially at the evening. Physical
examination showed edematous ankles, brown color stains on the skin around
the ankles, skin lesion, resistant to treatment. She does not have DM,
hypertension, but she had varices for more than 40 years. VF on admission HR
70 bpm/, BP 160/100 mmHg, BR 16 bpm.
- Define chronic venous insufficiency
- Explain mechanisms leading to clinical
presentation of this patient
- What additional signs and symptoms would
you expect?
- Explain relationships between varices, DVT and
development of chronic venous insufficiency
- Why she suffers from skin trophic changes
instead she has rather venous than arterial
disease?
- Explain mechanism of diffusion hypoxia
- Explain mechanisms od edema formation in
this case
Explain the problems with venous return in a subjects with varices