CHAPTER 13. VASCULAR AND LYMPHATIC INSUFFICIENCY OF THE EXTREMITIES
12 topics with brief reviews: definitions, key facts, and seminar questions.
In this chapter, we analyze one of the most dramatic topics in general surgery: vascular insufficiency of the extremities. Without understanding the pathogenesis and clinical presentation of these conditions, it is impossible to become a competent physician, as time often runs out in hours during acute ischemia, and the price of a mistake is the loss of a limb.
The section covers physical and instrumental examination methods for vascular patients, as well as key pathologies: acute and chronic arterial and venous insufficiency, obliterating atherosclerosis and endarteritis, and lymphedema. We will examine in detail the inevitable outcomes of impaired tissue trophism: necrosis, various types of gangrene, and the mechanisms behind the formation of trophic ulcers and fistulas.
During practical classes and exams, the differential diagnosis of obliterating atherosclerosis and endarteritis, the classifications of stages of chronic arterial and venous insufficiency, and the algorithmic approaches to acute thrombosis are tested most rigorously. Master this foundation firmly: in on-call practice, this knowledge saves lives.
Which symptom indicates the irreversibility of ischemic changes?
Development of complete anesthesia. If, when testing sensation with a needle, the patient can no longer distinguish between a pinprick and touch with a blunt object, this indicates non-viable tissue.
What is intermittent claudication?
This is the leading symptom of arterial insufficiency: severe pain in the calf muscles or foot during walking, forcing the patient to stop. After resting, the pain subsides, and walking can be resumed.
In what position should the popliteal artery be palpated?
The patient should bend the leg at the knee joint to achieve maximum muscle relaxation.
What is the basis of the disease's pathogenesis?
The disease represents a local manifestation of generalized atherosclerosis, which leads to severe chronic arterial insufficiency of the legs and the formation of pronounced ischemic syndrome.
Why does a patient stop feeling pain during complete tissue necrosis in gangrene?
Pain disappears due to the complete death of nerve endings in necrotic tissues. Until this moment, pain is caused by ischemic neuritis and is extremely intense.
Why does superficial vein thrombophlebitis not cause acute circulatory insufficiency?
Because the primary venous outflow from the extremities occurs precisely through the deep veins. When superficial veins are affected, blood flow is compensated via communicating veins, and local signs of inflammation predominate clinically.
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