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EPIDEMIOLOGIE
16 anipentru cancer
12 ani pentru boli cardio-vasculare
Traumatismele arteriale
Etiopatogenie
0,07
vasculare ntre
i 2,5% din totalul
traumatismelor(Candea).
La pacienii spitalizai pentru traumatisme ortopedice
incidena leziunilor vasculare depete
5%(Candea )
Traumatisme
Traumatisme inchise
Contuziile arteriale
ntlnit mai ales la nivelul aortei toracice la victimele accidentelor de vehicule de mare
vitez (autoturisme, motociclete).
Traumatisme deschise
Plagile arteriale
cavitaie.
Traumatisme iatrogene
Traumatisme iatrogene
b)manevre exploratorii
c) manevre terapeutice
Anatomia patologica
Contuzia arteriala
Anatomie patologica
Plgile i seciunile arteriale.
Hematom pulsatil
Pseudoanevrism
Diagnostic clinic
Hemoragia
Ischemia acuta
Ischemia acuta
ntreruperea fluxului sanguin determin ischemia esuturilor
extremitii perfuzate n mod normal de catre vasul lezat.
Diagnostic paraclinic
INVESTIGATII PARACLINICE
Examenul Doppler
O serie de examene non-invazive pot fi utile mai ales la pacienii la care semnele clinice nu
sunt evidente i la care se suspecteaz existena unor leziuni de importan minor. Sunt de
amintit aici msurarea etajat a tensiunii arteriale cu ajutorul probei Doppler (cu
calcularea indicilor de presiune arterial) i examenul echo-Doppler biplan (examenul Duplex).
Examenul Duplex este util nu doar pentru diagnosticul leziunilor vasculare, dar
i pentru monitorizarea pacienilor la care s-a optat pentru tratamentul conservator.
Rezultatele depind ns de experiena medicului care realizeaz examenul.
Arteriografia -Angiografia
Gradul de urgenta
Se admite c la nivelul muchilor
scheletici i al nervilor periferici apar
leziuni ischemice ireversibile dup
LUXATIE SCAPULO-HUMERALA cu
ischemie si pareza paralizie de
brat
TRATAMENT
PLAGA INJUNGHIATA
INTERPOZITIE VENA
Contuzie de AFC
Contuzie de AFC
Contuzie de AFC
Hemotorax
Plaga artera subclavie -
Figure 72-6
Postoperative CT scan
of a patient with a
gunshot wound shows
an aortocaval fistula
(circle).
Plaga carotida
angioplastie cu
petec venos
OPERATIVE MANAGEMENT:
GENERAL PRINCIPLES
CT of a traffic
accident victim shows
a large pelvic
hematoma (circle)
due to injury of the
right common iliac
artery.
CT scan with
intravenous contrast
material following a
fall from a significant
height shows poor
contrast uptake of the
right kidney due to an
occlusion of the renal
artery (circle).
Postoperative CT scan
of a patient with a
gunshot wound shows
an abdominal aortic
false aneurysm
(circle).
Pseudoanevrism de artera
axilara
Ischemia acuta
ETIOLOGIE
1. Embolia
2. Tromboza
ateromatoza
postoperatorie
hipovolemie
trombocitoza
tumori maligne
3. Spasmul
postoperator
adrenergica
dopamine...
4. Disectia
spontana
iatrogena
5. Compresie
TVP
post chirurgie
6. Trauma
contuzii si plagi
iatrogen
EMBOLIA ARTERIALA
1. CARDIACA
(80 la 90%)
2. ANEVRISMALA
SAU
ATEROMATOASA
3. EMBOLIA
PARADOXALA
Ateroembolism
T.E.E.
Transesophageal
echocardiogram demonstrating
mobile (seen on real-time
imaging) protruding aortic
atheromas located in the aortic
arch (A) and descending
thoracic aorta
(B). This patient has had
multiple strokes due to
atheromatous embolization
from the ascending aorta and
aortic arch.
Semne clinice
1. Pain
2. Paleness(palor)
3. Paresthesia
4. Pulselessness
5. Paralysis
6. Perishing cold
Fiziopatologia ischemiei
acute
Ischemia ireversibila
Dependent edema
and ischemic
blisters( vezicule)
seen in a patient
with acute
Irreversible limb
ischemia.
Manifestari clinice si
diagnostic
Absenta circulatiei
colaterale
Pacientul nu are semnal
Doppler in periferie.
Tratament chirurgical
Embolectomia cu sonda
Fogarty
Sindromul de
reperfuzie
determina
Sindromul de
compartiment
Rolul
fasciotomiei
Fasciotomia posterioara si
antero-externa
4. Disectia
spontana
iatrogena
5. Compresie
TVP
post chirurgie
6. Trauma
contuzii si plagi
iatrogen
Tromboza acuta
FACTOR
EMBOLISM
THROMBOSIS
Identifiable source
Frequently detected
None
Claudication
Rare
Frequent
Physical findings
Angiography
Minimal atherosclerosis,
sharp cutoff, few
collaterals, multiple
occlusions
Diffuse atherosclerotic
disease, tapered and
irregular cutoff, welldeveloped collateral
circulation
Tratamentul trombozei
acute
Diferentiat
RAR- embolectomie
Tromboliza locala
FRECVENT TEHNICI DE
DEZOBSTRUCTIE SAU BY PASS
Tromboliza locala
Disectia acuta
Fenestrare spontana
Tratament disectiei cu
ischemie acuta
Tasc
FIGURE 2. Digital subtraction pelvic arteriogram. (Left) There is a severe stenosis of the right
common iliac artery (arrow). (Center) Image hold. Deployment of a Palmaz stent mounted on
an angioplasty balloon, seen in its fully expanded state. (Right) Magnification digital
subtraction arteriogram center at the aortic bifurcation. Following stenting, the right common
iliac artery is widely patent.