VascularClaudicationvsLumbarStenosisHK中英文-培训课件.ppt

血管性跛行 PVD Has a poorer prognosis than cardiac disease with greater mortality statistics * Case study, could be claudicant but stops, not flexes, reducing distance, non-dermatomal therefore not foraminal stenosis, unilateral therefore not lumbar stenosis * Claudication distance = onset of pain Walking distance = ability with pain Rest time signifies collaterals – short time = big/good collaterals, long time = poor collaterals * Risk factors which lead to vascular disease Modifiable non-modifiable risk factors Can have concurrent MSK PVD disease 5% of PVD have AAA * Risk factors which lead to vascular disease Modifiable non-modifiable risk factors Can have concurrent MSK PVD disease 5% of PVD have AAA * Fem art / internal iliac art / external iliac art / superior iliac artery A block before the internal iliac artery gives whole leg pain ie gluteal, hip, leg = palp fem pulse A block at the internal iliac artery produces gluteal discomfort, reduced gluteal pelvic blood supply, assoc’d with erectile dysfunction = normal fem pulse, normal distal pulses External iliac artery gives posterior thigh calf pain = reduced fem pulse, reduced distal pulse, asymmetry left-right Superficial femoral artery =commonest claudicant, profunda femoris is a good collateral therefore graded exercise program works well Peripheral claudication ie below popliteus are more problematic, give rise to local peripheral symptoms * Claudication is non-limb threatening and needs differentiating from our stenotic patients Stage 4 is known as critical limb ischeamia is limb threatening, typified with pain @ rest ulcers/gangrene * Distal pulses are palpable @ 80 mmHg therefore are variable with BP fluctuation * Ventricular contraction (fwd) Ventricular rest, early atrial contraction (back) Late atrial contraction (Fwd) Loss of elasticity causes the sound of expansion phase is reduced rebound phase is diminished/absent * Stenosis = bilat/unilat, can be dermatomal, Radiculopathy = dermatomal d