
rakthakkuzhalukalude sasthrakriya

dhamanikal, sirakal allengil lymphatic naalangal ulppedunna rakthakuzhal rogangal medical therapy, minimali-invasive katheettar nadapadikramangal, sasthrakriya punarnirmmaanam enniva vazhi niyanthrikkunna oru shasthrakriya upavibhagamaanu vascular sarjari. hridayatheyo mattu avayavangaleyo chikilsikkaathe, rakthakkuzhalukalude maathram maanejment parishkaricha general, hridayasambandhamaaya shasthrakriyakalil ninnaan eee prathyekatha vikasichathu. aadhunika vascular sarjariyil ooppan sarjari teknikkukal, endovascular (minimali invasive) teknikkukal, vascular rogangalude medical maanejment enniva ulppedunnu-maathru savisheshathakalil ninnu vyathyasthamayi. rakthakkuzhalukalude sarjan, rakthakkuzhalukalude ellah bhaagangaleyum badhikkunna roganirnayathilum niyanthranatthilum pariseelanam nedunnu, coronarykalum intra craniel vasculature ozhike. rakthakkuzhalukalk sameepam sasthrakriya nadatthaan mattu doctormaare sahaayikkunnathino rakthasraavam niyanthrikkuka, vichedikkuka, adaykkuka allengil rakthakkuzhalukalude gadanakalude surakshithamaaya exposurinaayi ulppedunna rakthakkuzhalukalude parikkukal rakshikkunnathino vascular sarjanmaare vilikkunnu.
charithram.
aadyakaala shasthrakriya saankethikavidyakal vikasippichedutha russian sarjan nikkolaay korotkov, minimali invasive angioplasty (1964) kandupidichathinte bahumati nediya american interventional radiologist chaals theodor dotter, eee mekhalaye oru prathyekathayaayi amgeekarikkaan sahaayicha australian roobert paattan ennivar eee mekhalayile aadyakaala nethaakkalil ulppedunnu. 1970kalil amerikkayil oru speciality enna nilayil athinte amgeekaarathinaayi munnott povukayum rakthakuzhal shasthrakriyayil noothana pariseelanam vikasippikkukayum valarthukayum cheytha aadyakaala american pioneermaaril oraalaayirunnu saan fraansiskoyile edwin vaili. 1912 leeii nobal sammana jethaavaaya sarjan alexes carrell, rakthakkuzhalukal thunnicherkkaan upayogikkunna saankethikavidyakalkku rakthakuzhal shasthrakriyayile ettavum sradheyamaaya charitra vyakthiyaan.
parinamam.
operative arterial, veenas shasthrakriyakale adisthaanamaakkiyullathaanu eee speciality, ennaal 1990 kalude thudakkam muthal ithu valareyadhikam vikasichu. shasthrakriyaykk kuranja aakramanathmaka badalukalkku ippol ganyamaaya oonnal nalkunnundu. doow. yeppolulla interventional radiologistukalaanu eee mekhalaykku thudakkamittath. paathrangalude seeriyal dailetteshan upayogichu angioplasty kandupidicha chaals dotter. 
sarjan doow. thomas jeey. adanja paathrangalil ninnu kattakal neekkam cheiyunnathinaayi roopakalppana cheytha oru baloon katheettar fogarty kandupidichu, ithu endovascular angioplasty cheiyunnathinulla aathyanthika maathrkayaayi upayogichu. interventional radiology, vascular sarjari, interventional cardiology enniva thammilulla samyuktha sramangaliloodeyaanu eee mekhalayude kooduthal vikasanam sambhavichathu. vascular sarjariyude eee mekhalaye endovascular sarjari allengil interventional vascular radiology ennu vilikkunnu, eee padam specialityilulla chilar vascular sarjan enna nilayil avarude praadhamika yogyathayumaayi cherkkunnu. endovascular, endovenous nadapadikramangal (udha.jii., iwar) ippol oru vascular sarjante parisheelanatthinte bhooribhaagavum roopappeduthaan kazhiyum.
shareerathile ettavum valia dhamaniyaya iorta chikitsa randaam noottaandil vividha anyoorismukalkkaayi aadyamaayi sasthrakriyakal nadatthiya greak sarjan aantilasil ninnaan. maikkal debeki, denton cooley ennivayil ninnulla vikasanathilum purogathiyilumaanu iortic rogangalude aadhunika chikitsa. 1955-ll, debeki kooliyum oru thorassic aneurism oru hoomoographt upayogichu aadyamaayi maatti. 1958-ll avar daakron graaft upayogikkaan thudangi, athinte falamaayi iortic aneurism nannakkunnathil sarjanmaarkk oru viplavam undaayi. brachaeosephalic damaniyude integrade perfusion upayogichu aarohana iorta nannakkaan cardiopulmonary baipas nadatthiya aadya vyakthiyum addehamaanu.
doow. edward "tedu" dietrich, doow. debekkiyude koottaalikal, pinneedu endovascular shasthrakriyayude mukhamudrakalaayi marria ettavum kuranja aakramanathmaka saankethikavidyakalkku thudakkamittu. dietrich pinneedu 1998 ll arizona hart ashupatri sthaapikkukayum 1998 muthal 2010 vare athinte medical director pravartthikkukayum cheythu. 2000 ll, pottithericha vayarile iortic anyoorisathinu aadyathe endovascular aneurism repire (iwar) dietrich nadatthi. 2017 ll dietrichinte maranathethudarnnu sthaapanathinte medical director sevanamanushticha emm. dii. venkatesh ramaya ulppede arizona hart ashupathriyil endovascular sarjari mekhalayil niravadhi bhaavi nethaakkale dietrich parisheelippichu.
endovascular shasthrakriyayude vikasanathodoppam saadhaarana shasthrakriyayil rakthakkuzhalukalude sasthrakriya athinte uthbhavathil ninnu kramena verthirikkappedukayum cheythu. mikka vascular sarjanmaarum ippol avarude pariseelanam vascular sarjariyil maathramaayi parimithappedutthunnu, athupole, general sarjanmaarkk valia vascular sarjari pravartthanangalo mikka endovascular nadapadikramangalo parisheelippikkukayo parisheelippikkukayo cheyyilla. aduthide, professional vascular sarjari sosaittikalum avarude pariseelana paripadiyum vascular sarjari aupachaarikamaayi oru prathyeka specialityaayi verthirichu, athintethaaya pariseelana paripadi, metingukal, accreditation ennivayundu. amerikkayile sosaitti phoor vascular sarjari (ezz. vii. ezz), austreliya, nyoosiland sosaitti oof vascular sarjans (ansvis) ennivayaanu sradheyamaaya samoohangal. praadeshika samoohangalum nilavilundu (udha.jii.nyoo southu weils vascular aandu melbone vascular sarjikkal association (mvsa). valia shasthrakriya samghangal avarude kudakkeezhil prathyeka shasthrakriya samghangale sajeevamaayi verthirikkukayum prolsaahippikkukayum cheiyunnu (udha.jii.royal australian koleju oof sarjans (rax).
nilavil.
angiography, stenting, noonn-operative vericos weyin treatment sclerotherapy, endovence lazer treatment enniva vazhi arterial, veenas disease chikitsa pala aadya loka raajyangalilum valia shasthrakriyaykk pakaramaayi. eee nadapadikramangal kuranja rogaavasthayum marananirakkum ulla hraswakaala ashupathriyil (mikka kesukalilum pakalum rathriyum) thaamasikkanulla nettatthode shasthrakriyayumaayi thaarathamyappeduthaavunna nyayamaaya phalangal nalkunnu. charitraparamaayi interventional radiologistukal nadatthiya, vascular sarjanmaar endovascular reethikalil kooduthal praaveenyamullavaraayi mariyirikkunnu. endovascular arterial nadapadikramangalude eedu pothuve nallathaanu, prathyekichu avayude saadhaarana klinikkal upayogathinte pashchaathalatthil nokkumbol.iii. prayamaaya rogikalil sambhavikkunna dhamanikalude rogam saadhaaranayaayi oresamayam undaakunna rogiyude komorbidittikalumaayi bandhappettirikkunnu, prathyekichu ischemic hrudrogam. hraswakaala ashupatri thaamasathil ninnulla chelavu laabhikkunnathum rogaavastha kurravaayathum ganyamaanengilum imaging upakaranangalude uyarnna chelavu, samarppita nadapadikrama syoottukalude nirmmaanam, staafing, implaant upakaranangal enniva oru paridhivare santhulithamaanu.
cheruppakkaaraaya rogikalkkum sira rogathinum ulla gunangal kuranja bodhyappeduthunnavayaane rogiyude munganana, aarogya insurance kambaniyude chelavukal, idatharam kaalayalavilenkilum thaarathamyappeduthaavunna falaprapti prakadippikkunna pareekshanam ennivayaal nayikkappedunna nonparetteevu chikitsa oopshanukalilekku sakthamaaya pravanathakalundu.
oru swakaarya vascular sarjari klinikkumaayi bandhapetta otappetta divasathe angiography soukaryamaanu yunaittad stetsile sameepakaala pravanatha, angane mikka arterial endovascular kesukaludeyum chikitsa soukaryapradamaayum mothatthilulla kuranja community chelavilum anuvadikkunnu. sasthrakriya cheyyaatha sira chikilsaykkulla samanamaaya ashupatri ithara chikitsa soukaryangal kurachu varshangalayi nilavilundu, ippol pala raajyangalilum vyaapakamaanu.
aadyamaayi cheiyunna shasthrakriyayude bhaagamaayi 2018ll englandiludaneelamulla 70 vascular sarjari saittukalilum enhs englandu avalokanam nadatthi. vascular habbukal prathivarsham kuranjathu 60 adivayattile iortic aneurism nadapadikramangalum 40 caroted endaartterektamikalum nadathanamennu avalokanam vyakthamaakkunnu. 12 trasttukalkku rund lakshyangalum nashtamaayi, niravadhi perkku avayilonnu nashtamaayi. kurachu kendrangalil vascular sarjari kendreekarikkunnathinulla oru paripadi purogamikkukayaanu.
iorta, caroted dhamanikal, iliac, femoral, vascular troma, tbl dhamanikal ennivayulppedeyulla thaazhathe attangal ennivayude sasthrakriya vascular shasthrakriyayil ulppedunnu. rakthakkuzhalukalude shasthrakriyayil, meeii-thurner syndrome, vericos sirakal thudangiya avasthakalkkulla sirakalude sasthrakriyayum ulppedunnu. chila pradeshangalil, vascular shasthrakriyayil dialysis axus sasthrakriyayum traansplaant sasthrakriyayum ulppedunnu.
dhamanikalude rogangalude paripalanam.
coronary, intra craniel rogangal ozhikeyulla arterial paatholajiyude maanejment vascular sarjanmaarude paridhiyilaan. stenosis ennariyappedunna dhamanikalude ghadana idungiyathiloodeyo allengil aneurism ennariyappedunna asaadhaaranamaaya dilation moolamo aanu rogaavasthakal saadhaaranayaayi undaakunnath. dhamanikalude lumen idungaan kazhiyunna onniladhikam samvidaanangalundu, avayil ettavum saadhaaranamaayath rakthapravaham aanu. rogalakshanamulla stenosis dhamanikalude vichedanam moolamundaakunna sankeernnathakalum aakam. fibromuscular dysplasia, radiation induced fibrosis allengil sistik adventicial disease ennivayaanu stenosisinte mattu saadhaaranamallaatha kaaranagal. hystological paalikal nilanirthunna oru damaniyude valippathe aneurism ennu vilikkunnu. oru aneurism fusifom (concentric dilation), sacular (outpoaching) allengil iva randinteyum samyojanam aakam. moonnu hystological paalikal adangiyittillaatha dhamanikalude dilation oru seudoenurism aayi kanakkaakkappedunnu. koodaathe, vascular sarjan niyanthrikkunna rogalakshana rogathilekku nayikkunna niravadhi janmana vascular anomalukal undu, avayil chilathil apreethikaramaaya subclavian artari, poppilaittal artari entraapment syndrome allengil persentant sayaatik artari enniva ulppedunnu. vascular sarjanmar jeevitashaili parishkkaranam, marunnukal, endovascular therapy, sasthrakriya ennivayulppede niravadhi chikilsakal upayogichu dhamanikalude rogangal chikilsikkunnu.
aneurism.
iortic aneurism.
vayarile arayil othungunna iorta aneurismal dilatione soochippikkunnathu oru adivayattile iortic aneurism (aaa) aanu. saadhaaranayaayi, aneurism lakshanangalillaathathum infraareenal sthaanathaanu sthithicheyyunnathu. palappozhum, pukavali charithram polulla apakadasaadyathayulla gadakangalulla rogikalil avaa aakasmikamaayo screening parishodhanakalilo kandethunnu. 5 centimeteril thaazhe vyaasamulla anaerism ulla rogikalkku prathivarsham 1 sathamaanathil thaazhe pottanulla saadhyathayund. aneurism valippa maanadandangal paalikkumbol athu iortic replacement allengil iwar upayogichu chikilsikkaam.
thorassic iortic aneurism nenjil adangiyirikkunnu. avarohana iorta aneurism palappozhum thorassic endovascular iortic repire allengil tever upayogichu chikilsikkaam. aarohana iorta ulppedunna aneurism chikilsikkunnathu saadhaaranayaayi hridaya shasthrakriya vidagtharude paridhiyilaan, ennaal varaanirikkunna endovascular saankethikavidya chila rogikalil kooduthal kuranja aakramanathmaka sameepanam anuvadichekkaam.
nenjilum vayarilum vyaapikkunnavayaan thoroacoabodinal aneurism. crofford vargeekaranam vikasippikkukayum anchu tharam thoracoabodinal aneurism vivarikkukayum cheiyunnu.
mattu arterial aneurism.
iortayil ninnu undaakunna anaerism chikilsikkunnathinupurame, vascular sarjanmar shareerathile mattidangalilum anaerism chikilsikkunnu.
vrukka dhamani, pleeha dhamani, seliac dhamani, hepatic dhamani ennivayilekku verthirichirikkunnava visaral artari anyoorisangalil ulppedunnu. ivayil, pleanic artari aneurism aanu ettavum saadhaaranamenn daatta kaanikkunnu.
attakuttappanikalkkull soochanakal damanikalkkidayil alpam vyathyaasappettirikkunnu. udaaharanathinu, nilavile maargganirddeshangal 3 centimeteril kooduthalulla vrukka, pleeha artari anyoorisangalum prasavikkunna praayathilulla sthreekalil eathu valippathilullavayum nannakkaan shupaarsha cheiyunnu; athesamayam seliac, hepatic artari anyoorisangal avayude valuppam 2 centimeteril kooduthalaayirikkumbol nannakkaan soochippikkunnu. ithu mikacha mesentarik artari anyoorismukalil ninnu vyathyasthamaan, avaa kandethumbol valippam pariganikkathe nannaakkanam.
kaalmuttin pinniloode pookunna poppilaittal aarttariyil praadeshikavalkkarinchirikku oru arterial aneurisamaanu poppilaittal artari aneurism. vayattil sthithicheyyunna anyoorisangalil ninnu vyathyasthamayi, poppilaittal artari aneurism apoorvvamaayi villalukalodeyaanu kaanappedunnath, marichu thrombasinte embolisation kaaranam acute limb iskeemiyayude lakshanangalodeyaanu. athinaal, oru rogikk 2 centimeteril kooduthal vyaasamulla lakshanangalillaatha poplaittal aneurism undaakumbol, oru vascular sarjanu niravadhi gadakangale aashrayich vascular baipas allengil endovascular exclusion nalkaan kazhiyum.
dhamanikalude vichedanam.
damaniyude mathil moonnu kendreekritha paalikalaal nirmmithamaann inttima, media, adventishya. pothuve, dhamanikalude mathilinte ettavum ullile paaliyile oru kanneeraan dhamanikalude vichedanam, athu rakthathe ozhukaan anuvadikkukayum paalikalkkidayil shekharikkukayum cheiyunnu. dhamanikalude vichedanangalil iva ulppedunnu iortic vichedanam (iorta), coronary artari vichedanam (coronary artari), kazhuthile dhamanikalilonn ulppedunna rund tharam servical artari vichedanam-caroted artari vichedanam (caroted artari), vertebral artari vichedanam (vertebral artari), pulmonary artari vichedanam ennathu vittumaaraatha pulmonary hypertensionte sankeernnatha enna nilayil valare apoorvamaaya avasthayaanu.
saadhaaranayaayi hridaya shasthrakriya vidagtharkku tharam eiii vichedanam kaikaaryam cheyyaanulla chumathalayundenkilum, tharam bii vichedanam saadhaaranayaayi vascular sarjanmaaraan kaikaaryam cheiyunnathu. type bii iortic vichedanam ettavum saadhaaranamaaya apakada gadakamaanu hypertension. type bii iortic vichedanam cheiyunnathinulla aadya nira chikitsa hridayamidippum rakthasammardhavum kuraykkaan lakshyamidunnu, ithine aanti-impulse therapy ennu vilikkunnu.
prarambha medical maanejment paraajayappedukayo iorta oru pradhana shaakhayude pankaalittham undaakukayo cheythaal, eee tharam bii vichedanangalkku vascular sasthrakriya aavashyamaayi vannekkaam. caroted-caroted baipas, caroted-subclavian baipas, allengil subclavian-caroted transposition polulla extra-anatomic bipassinoppam allengil illaathe thorassic endovascular iortic repire (tever) chikilsayil ulppedaam.
visaral artari vichedanam.
mikacha messentic dhamani, seliac dhamani, vrukkasambandhamaaya dhamanikal, hepatic dhamani ennivayum mattum ulppedunna dhamanikalude vichedanangalaanu visaral dhamanikalude vichedanam. avaa oru iortic vichedanam oru vipuleekaranamaakumbol, eee avastha iortic chikilsayiloode oresamayam kaikaaryam cheiyunnu. ottappedalil, moonnilonnu rogikalil visaral artari vichedanam aakasmikamaayi kandethunnu, eee sandarbhangalil oru vascular sarjan vaidyashaasthraparamaayi kaikaaryam cheyyaam. vichedanam avayavangalkk kedupaadukal varuthunna sandarbhangalil sasthrakriya aavasyamaanennu vascular sarjanmar pothuve amgeekarikkunnu. shasthrakriyayude maanejment thanthrangal anubandha sankeernathakal, shasthrakriyayude kazhivu, rogiyude munganana ennivaye aasrayichirikkunnu.
mesentarik ischemia.
superior messentic artari (sma) yude theevramo vittumaaraathatho aaya thadassathil ninnaan messentic ischemia undaakunnath. sma adivayattile iortayil ninnu uthbhavikkukayum saadhaaranayaayi vidoora duvodeenathil ninnu transwers vankudalinteyum pancreasinteyum moonnil rund bhaagatthiloode raktham vitharanam cheyyukayum cheiyunnu.
vittumaaraatha messentic ischemia.
vittumaaraatha messentic iskeemiyayude lakshanangale vayarile aanjina ennu tharamthirikkaam, ithu bhakshanam kazhichu oru nischitha kaalayalavil sambhavikkunna vayaruvedanayaanu. ithumoolam, rogi bhakshanam kazhikkunnath ozhivaakkukayum ithu aasoothrithamallaatha sareerabhaaram kuraykkaan kaaranamaakukayum cheyyum. aadyathe sasthrakriya nadathunnathu aarr aanennu karuthappedunnu.ezz. shhaa 1958-ll nyoo englandu jenal oof medisinil vivarikkukayum cheythu. shhaa vivaricha nadapadikramatthe mesentarik endarterectomy ennu vilikkunnu. athinusesham, angioplasty, stenting ennivayulppede kuranja aakramanathmakavum endovascular saankethikavidyakalilum chikilsayil niravadhi purogathikal undaayittund.
acute mesentarik ischemia.
suuppar messentic damaniyude pettennulla adavukalude falamaanu acute messentic ischemia (amii).
rakthaathimarddam naveekarikkuka.
vrukkakalude dhamanikal vrukkakalilekku ooksijan adangiya raktham vitharanam cheiyunnu. vrukkakal vellappokkathe filter cheyyaanum renin-angiotensin samvidaanathiloode rakthasammardham niyantrikkaanum sahayikkunnu. resistant hypertensionte oru kaaranam vrukkasambandhamaaya dhamanikalile raktapravaaha rogamaanu, ithine saadhaaranayaayi renovascular hypertension ennu vilikkunnu. renovascular hypertension kandethukayum uyarnna rakthasammardham niyanthrikkunnathil paramavadhi medical paraajayappedukayum cheythaal, vascular sarjan endovascular allengil ooppan sarjikkal punarnirmmaana sasthrakriya nalkaam.
cerebrovascular rogam.
extra craniel cerebrovascular rogathe chikilsikkunnathinum caroted ultrasonography, transcranial doppler thudangiya extra craniel, intra craniel rakthachamkramanavumaayi bandhapetta noonn-invasive vascular imajinginte vyaakhyaanathinum vascular sarjanmaar utharavaadikalaanu. vascular sarjanmar chikilsikkunna cerebrovascular avasthakalil ettavum saadhaaranamaayath caroted artari stenosisaanu, ithu caroted dhamanikalude idungiyathum klinikkal rogalakshanamo lakshanangalillaathatho (nishabdam) aakam. caroted artari stenosis rakthapravaham moolamundaakunna oru rakthakkuzhalinullile raktapravaaha phalakam nirmmikkunnath idungiyathinu kaaranamaakunnu.
caroted artari stenosisinte lakshanangalil shanikamaaya ischemic aakramanamo stroco ulppedaam. caroted duplexes altraasoundinte sahaayathode rogalakshanavum lakshanarahithavumaya caroted stenosis nirnnayikkaan kazhiyum, ithu edungiyathinekkurichula theevratha kanakkakkaanum phalakathinte swabhaavam vyakthamakkaanum anuvadikkunnu. chikilsayil medical therapy, caroted endarterectomy allengil caroted stenting enniva ulppedaam.
extra craniel cerebrovascular rogam kaikaaryam cheiyunnathinulla klinikkal practies maargganirddeshangal sosaitti phoor vascular sarjari prasidheekarikkunnu. vascular sarjanmaar chikilsikkunna cerebral sarkkuleshan ulppedunna saadhaaranamallaatha rogangalil vertebrobassilar aparyapthatha, subclavian steel syndrome, caroted artari desection, vertebral artari desection, caroted body tumour, caroted artari aneurism enniva ulppedunnu.
peripheral artari rogam.
kaikaalukalkk vitharanam cheiyunna dhamanikalude asaadhaaranamaaya idungalaanu peripheral artari disease paadu. eee avasthayulla rogikalkku edaykkideyulla klaudikkeshan undakam, ithu pradhaanamaayum nadakkumbol kaalakkuttikalilum thudakalilum vedanayaanu. purogathi undengil, oru rogikk vittumaaraatha avayavangal undakam, ithu vishramathil vedana sukhappeduthaatha murivukalum ulkkollunnu. paadinte roganirnayam, medical maanejment, endovascular, ooppan sarjikkal chikitsa ennivayil vidagtharaayavaraanu vascular sarjanmar.
oru vascular sarjanu charithram, shaareerika parisodhana, medical imaging ennivayude samyojanam upayogichu paadu nirnnayikkaam. medical imajingil kanankaal-brackial soochika, doppler ultrasonography, computed tomography angiography enniva ulppedaam. chikilsakal vyakthigathamaan, koodaathe medical therapy, endovascular edapedal allengil angioplasty, stenting, etherectomy, endarterectomy, vascular baipas ennivayulppedeyulla ooppan sarjikkal oopshanukal ulppedaam.
sira rogangalude paripalanam.
vittumaaraatha sira rogangal.
reticular sirakal, vericos sirakal, vittumaaraatha veekkam, veekkam ennivayilekku nayikkunna thaazhathe attathulla siraasampradaayathil raktham asaadhaaranamaayi shekharikkappedunnathaanu vittumaaraatha sirakalude aparyapthatha. vittumaaraatha sirakalude aparyapthatha 40 sathamaanam sthreekaleyum 17 sathamaanam purushanmareyum baadhikkunnuvenn janasamkhyaa kanakkukal soochippikkunnu. vittumaaraatha aparyapthatha vedana, veekkam, charmmatthil maattam ennivayilekku nayikkumbol athine vittumaaraatha sira rogam ennu vilikkunnu. vittumaaraatha sirakalude aparyapthatha (sii. vii. aii) poost-thrombotic syndromil (pii. tii. ezz) ninnu verthirikkappedunnu, sii. vii. aii praadhamikamaayi upariplavamaayatho aazhathilullatho aaya sirakalude valvular kazhivillaaymayude prasnamaanu, athesamayam pii. tii. ezz deerghakaala sankeernathayaayi sambhavikkam.
vaidyashaasthra, edapedal, sasthrakriya nadapadikramangal ennivayulppede thaazhnna attathulla sira rogathe chikilsikkaan vascular sarjanu niravadhi reethikalundu. udaaharanathinu, unnaayude boottukal, radiophrequency ulla upariplava sira reflexes, soochippichaal lazer ableshan allengil weyin stripping enniva upayogichu sirayude alsar chikilsikkaam. soochippikkumbol, aazhathilulla sirakalile aparyapthatha aantharikamo baahyamo aaya valvuloplasty upayogichu sirakalude vaalvukalude punarnirmmaanatthiloode chikilsikkaam.
vericos sirakal.
uparithala sirakal neraaya sthaanathu 3 millimeteril kooduthal valichedukkukayum (valuthaakkukayum) tortus (snacklick) aakukayum cheiyunna avasthayaanu lover extermity vericos weins. duplexes ultrasonography upayogichu parishodhikkumbol kazhivillaathatho thettaayatho aaya vaalvukal palappozhum eee sirakalil kaanapedunnu. rakthakkuzhalukalude chikilsayil compression stocking, veenas ableshan allengil weyin stripping enniva ulppedaam, ithu rogiyude prathyeka avatharanam, rogathinte theevratha ennivaye aasrayichirikkunnu.
nonthrombotic iliac sirayile shathangal.
nonthrombotic iliac weyin shathangalil (nvl) meeii-thurner syndrome (mts) ulppedunnu, athil idathu iliac sirayude puranthallal saadhaaranayaayi valath iliac dhamani vazhi idathu kaalinte aswasthatha, vedana, veekkam, vericos sirakal ennivayilekku nayikkunnu. valathotto idathotto ulla iliac sirakalude compression nivil ulkkollunnu. vascular sarjanmaar rogiyude avatharanathe aashrayich vyathyastha chikitsa reethikal vaagdaanam cheythekkaam. kuranja aakramanathmaka diagnostic, chikitsa oopshanukalil intravascular ultraasoundu, venography, iliac weyin stenting enniva ulppedaam, athesamayam refractory kesukalil sasthrakriya maanejment vaagdaanam cheyyaam. sasthrakriya maanejment thanthrangalil palma nadapadikramam ennum ariyappedunna cross-pubic veenas baipas polulla badhita vibhaagathinte punarnirmmaanam allengil baipas ulppedunnu.
aazhathilulla sira thrombosis.
aazhathilulla sirayil thrombus roopappedunnathaanu deep weyne thrombosis (dii. vii. tii). mukalile attathekkaalum allengil jugular sirayekkaalum thaazhathe attathaanu dii. vii. tii undakanulla saadhyatha kooduthal. oru dii. vii. tiyil pelvik, lover extermity sirakal ulppedumbol athine chilappol iliophemoral dii. vii. tii ennu tharamthirikkaam. eee kesukalil edapedunnathu prayojanakaramaakumenn soochippikkunna chila thelivukal mattu thelivukal cheiyunnilla. mothatthil, iliophemoral dii. vii. tii. kku chila nadapadikramangalkku vidheyaraakunna rogikalil poost-thrombotic syndrome undaakunnathil kuravundaayekkaamennu daatta kaanikkunnu, pakshe ithu apakadasaadhyathakalillaathalla. oru vascular sarjan venogram, endovascular sakshan allengil mechanical thrombectomy, chila sandarbhangalil pharmacomecanical thrombectomy enniva nalkiyekkaam. chila thaazhnna attathulla dii. vii. tii. kku flegmassia serulia dolense allengil flegmassia alba dolense enna avasthaykku kaaranamaakunnathra kadinamayirikkaam, ithu avayavangalkk bheeshaniyaakunna sambhavangalaakam. flegmassia undaakumbol, edapedal palappozhum aavasyamullathaanu, athil sirakalude thrombectomy ulppedaam.
poost-thrombotic syndrome.
poost-thrombotic syndrome (pii. tii. ezz) chilappol dii. vii. tiyude deerghakaala sankeernathayaayi sambhavikkunna oru medical avasthayaanu, koodaathe deerghakaala edema dii. vii. tiyethudarnnulla charmma maattangalum ithinte savisheshathayaanu. chorichil, vedana, njerukkangal, paarastheshiya enniva rogalakshanangalil ulppedaam. 20 muthal 50 sathamaanam vare rogikalkku oru paridhivare pii. tii. ezz anubhavappedumennu kanakkaakkappedunnu. pii. tii. asinaayulla oru chikitsa thanthrathil compression stockingukalude upayogam ulppettekkaam.
pulmonary embolism.
acute pulmonary embolisathinte (pulmonary thrombectomy) sasthrakriya nadatthippu asaadhaaranamaanu, mosham deerghakaala phalangal kaaranam ithu upekshikkappettu. ennirunnaalum, aduthide, shasthrakriyayude saankethikavidyayude punaravalokanatthode ithu punarujjeevanatthiloode kadannupoyi, chila aalukalkk ithu gunam cheiyumennu karuthappedunnu. pulmonary hypertensionilekku nayikkunna vittumaaraatha pulmonary embolism ("chronic thromboempolic hypertension" ennariyappedunnu) pulmonary thromboendertectomy ennariyappedunna oru shasthrakriyayiloode chikilsikkunnu.
compressive venopathy.
aduthulla gadanakalo pindangalo valia sirakalude compression meeii-thurner syndrome (emm. tii. ezz), nutcracker syndrome, superior vena kaava syndrome ennivayulppede vyathyastha klinikkal syndromecalilekku nayichekkaam. chikilsaareethikalil venography, intravascular ultraasoundu, veenas stenting, kooduthal aakramanathmakamaaya ooppan veenas punarnirmmaanam, baipas enniva ulppedunnu.
hemodialysis axus maanejment.
vittumaaraatha vrukkarogamulla rogikalkku avarude raktham filter cheiyunnathinu vrukkamaatta chikitsa aavasyamulla rogathinte purogathi undakam. eee chikilsayude oru thanthram hemodialysis aanu, ithu oru rogiyude raktham filter cheyth maalinya uthppannangal neekkam cheyyukayum avarude raktham avarkk thirike nalkukayum cheiyunna oru prakriyayaan. aavarthichulla dhamanikalude aaghaatham ozhivaakkunna oru reethi oru arteriovanus fisttula (avf) srishtikkuka ennathaanu. eee aavashyathinaayi vivaricha aadyathe nadapadikramatthinu simino fisttula ennu namakaranam cheythu, ithu aadyamaayi vijayicha oru shasthrakriya vidagthante perilaanu. vascular sarjanmaar oru rogikk oru avf srishtikkukayum fisttula pettant aayi thudarunnuvennu urappakkaan kuranja aakramanathmaka nadapadikramangal ettedukkukayum cheyyaam.
vascular tromayude maanejment.
rakthakkuzhalukalude aaghaatham manassilakkaanulla oru maarggam rakthakkuzhalukalude parikkine moonnu maanadandangalaal tharamthirikkuka ennathaanu parikkinte samvidaanam, parikkinte shareeraghadana, sandarbhochitha saahacharyangal. parikkinte samvidaanam ettiyolajiye soochippikkunnu, udha.jii. itrogenic, moorchayulla, thulachukayarunna, spotana parikk muthalaayava. shareeraghadanayude sthaanam pravartthanaparamaayi soochippikkunnathu compress cheyyaavunnathum compress cheyyappedaathathumaaya rakthasraavamundo ennathine soochippikkunnu, athesamayam sandarbhochitha saahacharyangal sivilian allengil sainika mekhalayil sambhavicha parikkukaleyaanu soochippikkunnathu. oro sandarbhatheyum kooduthal vibhajikkaam sainikar poraattakkaaranum ethiraali. nagravum grameenavum thammilulla ettumuttalillaathum sivil aaghaathavum. eee vargeekarana padhathikku epidemiological, klinikkal praadhaanyamund. udaaharanathinu, sainika poraalikalile dhamanikalile parikk nilavil pradhaanamaayum sambhavikkunnath avarude irupathukalil praayamulla purushanmaarilaan, avar mechappetta spotaka upakaranangal allengil vedivayppu murivukalkk vidheyaraanu; athesamayam sivilian mekhalayil, amerikkayil nadatthiya oru padanatthil motor vahana koottiyidi, thokku parikkukal, kuthetta murivukal, uyarathil ninnu veezhal enniva ulppeduthunnathinulla ettavum saadhaaranamaaya samvidaanangal kaanichu.
moorchayulla thorassic iortic parikk.
vascular sarjariyile purogathi, prathyekichu endovascular saankethikavidyakal, moorchayulla thorassic iortic injuri (bii. tii. eiii. aii) yilekkulla operative sameepanathil naadakeeyamaaya maattathinu kaaranamaayi. motor vahana koottiyidi allengil uyarathil ninnu veezhal polulla thondayodulla athivega apamaanathil ninnaan bittay undaakunnath. computed tomography angiography allengil intravascular ultraasoundu ennivayil kaanunnathupole iorta shareeraghadana paalikalkku kedupaadukal sambhavikkunnathinte vyaapthiye adisthaanamaakkiyullathaanu vyaapakamaayi upayogikkunna oru vargeekarana padhathi. grade 1 bii. taay iortic inttima keerunnavayaan; grade 2 parikkukal intraamural hematomaye soochippikkunnu; grade 3 parikkukal seudoenurism aanu, avaa saahasika tissue maathram adangiyirikkunnu; grade 4 nettiyilekkum chuttumulla tissuevilekkum raktham swathanthramaayi pottunnathine soochippikkunnu. soochippikkumbol, aadya variyil edapedunnathil tever ulppedunnu.
pariseelanam.
munbu pothu shasthrakriyaykkulle oru mekhalayaayi kanakkaakkappettirunna ithu ippol athintethaaya oru prathyekathayaayi kanakkaakkappedunnu. thalphalamaayi, amerikkayil parisheelanathinu rund vazhikalundu. parambaraagathamaayi, anchu varshathe general sarjari residensic sesham 1-2 varshathe (saadhaaranayaayi 2 varsham) vascular sarjari fellowship undu. ancho aaroo varshathe vascular sarjari residency nadatthuka ennathaanu mattoru maargam. pala raajyangalilum, vascular sarjanmaarkk hridaya shasthrakriyayilum poost residensiyilum adhika pariseelanam thiranjedukkaam.
lokathinte vividha pradeshangalkkidayil pariseelana paripaadikal alpam vyathyaasappettirikkunnu.