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GP1 Atherosclerosis.Disease of the aorta and peripheral arteries (Aortic…

- - - - in carotid arteries
        
        stroke
        
        transient cerebral ischemia 短暫性腦缺血
      - in coronary arteries
        
        myocardial infraction
        
        angina pectoris
      - in peripheral arteries
        
        intermittent claudication 間歇性的跛行
        
        gangrene壞疽
  - - - accumulation of
        
        fatty acid
        
        leucocytes
        
        extracellular matrix
      - leads to
        
        fibrosis
        
        calcification
        
        neovascularization 新生血管
      - intermediate lesion--> atheroma動脈粥樣硬化--> fibrous plaque
    - - fibrous break or have fissure
      - blood+ extracellular--> triggers cloth formation (thrombus血栓)
        
        occlude the artery 阻塞動脈
        
        emboli distally 遠端栓塞
    - - Low density lipoproteins leaks through the intima內膜
        
        lipoprotein oxidation
        
        nonenzymatic glycation 非酶糖化(diabetic patient )
      - leucocyte recruitment
        
        monocyte
        
        lymphocyte
      - foam cell(泡沫細胞) formation
      - foam cell--> fatty streak
  - - - • Cigarette smoking
      - • Hypertension (BP >140/90 mmHg)
      - • Low HDL cholesterol (>40 mg/dL)
      - • Diabetes mellitus
      - • Family history of premature CHD(冠心病)
        
        in male first-degree relative 55 years
        
        in female first-degree relative 65 years
      - Lifestyle
        
        obesity (30kg/m2)
        
        physical inactivity
        
        Atherogenic diet 致動脈粥樣化飲食
      - Age (men>45 years; women>55 years)
  - - - acute myocardial infraction
      - angina pectoris
    - - stroke
      - Doppler study
      - carotid endarterectomy頸動脈內膜切除術
    - - cause hypertension
      - doppler study
      - arteriography動脈造影
      - intravascular stenting 血管內支架置入術
    - - mesenteric angina
        
        postprandial pain餐後疼痛
        
        arteriography
        
        by-pass of stenting 支架旁路
      - mesenteric ischemia
        
        necrosis of bowel
        
        emergency laparotomy 急診剖腹手術
        
        due to emboli
    - - intermittent claudication
        
        Pain in MMII when walking
        
        arteriography
        
        stent or by-pass
        
        doppler
      - Leriche's syndrome
        
        infrarenal aortic stenosis
        
        doppler
        
        claudication+ impotence
        
        arteriography
        
        by pass or stenting
      - arterial embolism
        
        doppler study
        
        emergency thrombectomy 血栓切除術
        
        pain, impotence性無能, coldness
- - - - saccular囊狀
      - fusiform梭形
      - pseudoaneurysm假性動脈瘤
    - - abdominal
      - thoracoabdminal胸腹
      - thoracic
  - - - marphan
      - Ehlers -Danlos
    - - syphilis
      - mycotic黴菌性
      - tuberculosis結核
  - - - Endovascular
      - Surgical
    - - no previous measurement
      - Limited grahs available
      - emergency
- - - - • Anticoagulants: oral or heparins•抗凝血劑：口服或肝素
      - • Thrombolytic drugs•溶栓藥物
      - • Low weight heparins低重量肝素
    - - vascular damage
      - hyper coagulability
      - stasis of blood flow血流淤滯
    - - 10-40%in abdominal or thoracic surgery
      - 50%in orthopedic surgery骨科手術(hip or knee replacement)