Claudicación

Intermitente: EVNI
Valentina Cabrera Salzmann
R1 Cirugia HNAN
Universidad de Valparaiso
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 Table of contents

01 Backgrounds 03 Reminder 05 Homework

You can describe the You can describe the You can describe the
topic of the section topic of the section topic of the section
here here here

02 Avatars 04 Planning 06 Others

You can describe the You can describe the You can describe the
topic of the section topic of the section topic of the section
here here here
 Enfermedad Arterial Oclusiva
Enfermedades vasculares causadas por la aterosclerosis de la aorta abdominal, iliaca o
extremidades inferiores que conducen a la estenosis u oclusión

Prevalencia 3-10%
Acentuada en >70años
Asintomatica: Sintomatica 1:3

Factores de riesgo Riesgo elevado de enfermedad

Raza negra cardiovascular
Relacion hombre: mujer1:1 2:1
Incremento Prevalencia con edad
Tabaquismo
DM - HTA
DLP
>70 años
Causas posibles
Aterosclerosis
Enfermedad embolica
Trauma
Arteria ciatica persistente
Tromboangeitis de Buerger-
Obliterante
Enfermedad adventicia quistica
Displasia fibromuscular
Atrapamiento de arteria poplitea
Arteritis
Anatomia
 Claudicacion Isquemia critica

Fatiga reproducible en Dolor en pierna distal en

Asintomaticos extremidades inferiores reposo con o sin ulceras
ITB anormal en reposo muscular o molestia al isquémicas o gangrena
o después de ejercicios hacer esfuerzos. Alivia
con el reposo en 10 min 1-2%
20-50%
10-35%
Clinica
 Historia
Factores de riesgo
Deterioro progresivo al
caminar
Dolor en las extremidades
Heridas con difícil curación
Capacidad funcional
Sintomas CV
Sintomas
Dolor extremidades
Claudicacion intermitente
Ulceras isquemicas

Examen físico:
Signos vitales descartar infección
Cambos de piel y fanereos
Exploracion vascular: pulsos
periféricos, soplos, temperatura,
color, ex. Neurologico de EEII, test de
buerger
 • Gluteo
Aorto-iliaca • muslo
• Gemelar

• gemelar
femoro
poplitea • si/no
plantar

Infrapoplitea • plantar
Diagnostico
 ITB

<0.9 0.9-1.3 >1.3 Indice Tobillo/Brazo

● PA sistólica en reposo en el
EAO Normal Doppler tobillo vs PA sistólica en reposo
braquial
● Relacion entre las dos presiones
Presiones
Dedo
 Pletismografia de dedo
Evalua la perfusión a nivel del pie
Registra forma de onda al desinflar el cuff
Medicion de presión en que la onda retorna a forma inicial
Normal 0.7-0.8

Presiones segmentarias
Orienta localización de EAO
Cuff sobre rodilla, bajo rodilla y sobre tobillo

PVR
Mide cambios de volumen en extremidad creando onda de pulso
Util para detectar obstrucción en arterias calcificadas
 US
ECO DUPPLEX: determina severidad y localización de la estenosis
Modo B: características de la lesión y ateroma
Doppler color y doppler pulsado: estimación de la gravedad de la estenosis.

Angiografia por RNM

Requiere gadolinio
Sens 90% y espcf 97% en la detección de estenosis
signoificativas en arterias de EEII

AngioTC
Mejor visualización de tejidos blandos
Menos invasividad
Menos especificidad en arterias tibiales comparado con territorio aorto-
iliaco
 Oxigeno Transcutaneo
Informacion adicional respecto a la perfusión tisular local
Evaluar el potencial de curación de ulceras de las extremidades inferiores o en los sitios de amputacion

Angiografia con contraste

Goldstandard
Clasificacion
Manejo
Programa de ejercicio supervisado: caminatas 30-45 min 3-4 veces por semana
Disminuye el dolor y mejora la distancia de claudicación, disminuyendo el riesgo CV

Manejo comorbilidades
HTA <140/90 si DM o ERC 130/80
DM < 7% HB1AC

Cese tabaco
Tabaquismo aumenta 3 veces riesgo de falla en revascularizacion
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 Homework

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● Paint mural
● Do spelling homework
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Monday Tuesday Wednesday
08:00 | Go to class 17:00 | Study for Friday 10:30 | Relax time

16:30 | Do homework 18:00 | Maths class 19:00 | Piano Lesson

Thursday Friday Saturday

08:00 | Breakfast 07:30 | Review for exam 11:00 | Do homework

09:30 | Music class 11:30 | Science test

Sunday
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Menu

05
Homework
 Write your homework
Monday - 5th april, 2021

Science Do science homework

Maths

Music

Art Draw a mural

 Write your homework

Mon Tue Wed Thu Fri

Read to book Do Science Draw Translate text Play piano

Study Maths Study Music Exercise 1

Do grammar
 Timetable
Mon Tue Wed Thu Fri
8:00 - 8:30 Music Science Language English Science

8:30 - 9:00 Art English Maths Music Art

9:00 - 10:00 Language Maths Science Art Language

10:00 - 10:45 Lunch

11:30 - 12:30 Maths Art Music Language Music

12:30 - 13:30 Science Music Art Maths Maths

 Test
Part 1
1. Link it:
a. Is a gas giant and the biggest planet Venus
b. Has a beautiful name, but it’s hot Mars
c. Despite being red, is a cold place Jupiter

2. Write the missing data:

Mass Diameter Gravity

100 355 ?
 Test
Part 1I
3. Describe Venus: It’s the second planet in the Solar System and It
has a beautiful name

4. Make a list of synonyms of the given word:

Planet ? ? ?

? ? ? ?
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 Infographic

Mars Jupiter Saturn Neptune

Despite being Jupiter is a gas giant It’s composed Neptune is the
red, Mars is a and the biggest of hydrogen farthest planet from
cold place planet and helium the Sun
 Infographic

Saturn Mercury
Saturn is composed of Mercury is the closest
hydrogen and helium planet to the Sun

Neptune Mars
Neptune is the farthest Despite being red, Mars
from the Sun is a cold place
 Infographic

Mars Saturn Jupiter

Despite being It’s composed Jupiter is a gas giant
red, Mars is a of hydrogen and the biggest
cold place and helium planet
 The slide title goes here!

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 3,450
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 Notes

Mercury Venus Mars

Mercury is the closest Venus is the second Despite being red, Mars
to the Sun planet from the Sun is a cold place

Saturn Neptune Jupiter

It’s composed of Neptune is the farthest It’s a gas giant and the
hydrogen and helium from the Sun biggest planet
 Percentages

32% 60% 88%

Mercury Neptune Saturn

Mercury is the closest Neptune is the farthest Saturn is a gas giant and
to the Sun from the Sun has several rings
This is a map

Venus
It has a nice name, but It’s
terribly hot
 333,00000
Earths is the Sun’s mass

24h 37m 23s

is Jupiter’s rotation period

386,000km
is a very long distance
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 This is a graph

Mars 40%
Despite being red, Mars
is a cold place Neptune 35%
Neptune is the farthest
Saturn 25% from the Sun

It’s composed of
hydrogen and helium

To modify this graph, click on it, follow the link,

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 Conclusions

Mercury Venus Mars

Mercury is the closest Venus is the second Despite being red, Mars
to the Sun planet from the Sun is a cold place
Need more columns of text?

Mercury Mars
Mercury is the closest Despite being red, Mars
to the Sun is a cold place

Venus Jupiter
Venus is the second It’s a gas giant and the
planet from the Sun biggest planet
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