2024-
2025
Vaatpathologie
PROF DR FOURNEAU EN PROF DR VERHAMME
JOZEFIEN CEULEMANS
,Semiologie van het arteriële, veneuze en lymfatische stelsel ............................................... 11
Arterieel stelsel .................................................................................................................... 11
Chronische arteriële insufficiëntie onderste ledematen ................................................. 12
Symptomen .................................................................................................................. 12
Acute ischemie ................................................................................................................. 14
Chronische arteriële insufficiëntie van de viscera ........................................................... 14
Arteriële insufficiëntie van de extracraniële vaten .......................................................... 15
Aneurysmatisch lijden ...................................................................................................... 15
Functionele semeiologie: niet-invasief vasculair onderzoek ................................................. 16
Inleiding ................................................................................................................................ 16
Onderzoeken bij perifeer arterieel lijden ............................................................................. 17
Enkel arm index EAI .......................................................................................................... 17
Interpretatie ................................................................................................................. 17
Beperkingen ................................................................................................................. 17
Duplex slagader ................................................................................................................ 18
Transcutane O2-meter ................................................................................................. 18
Onderzoek veneuze insufficiëntie ........................................................................................ 18
Klinsiche verdenkingg veneuze thrombose ..................................................................... 18
Duplex........................................................................................................................... 18
Spataders .......................................................................................................................... 19
Extracraniele vaatpathologie ............................................................................................... 19
Duplex halsslagaders ........................................................................................................ 19
Subclavian steal syndrome ................................................................................................... 19
Vasospastische aandoeningen ............................................................................................. 19
Capillaroscoop .................................................................................................................. 19
Andere aandoeningen ...................................................................................................... 20
Stolling en antistolling ............................................................................................................. 20
Inleiding ................................................................................................................................ 20
Basisprincipes van bloedstolling .......................................................................................... 20
Bloedvatwandbeschadiging ............................................................................................. 20
Bloedingstijd ................................................................................................................. 21
Stollingscascade ............................................................................................................... 21
Onderzoek van bloedstolling................................................................................................ 22
PT ...................................................................................................................................... 22
aPTT .................................................................................................................................. 22
1
, D-dimeren......................................................................................................................... 22
Gespecialiseerde stollingstesten ...................................................................................... 22
Antitrombotica ..................................................................................................................... 22
Antiaggregantia ................................................................................................................ 22
Anticoagulantia ................................................................................................................ 22
VitK antagonisten ......................................................................................................... 23
Heparines: .................................................................................................................... 23
DOACs en NOACs .......................................................................................................... 24
Procedure bij pt met anticoagulatie ............................................................................ 25
Fibrinolytica .................................................................................................................. 25
Complicaties ..................................................................................................................... 25
Verdieping ............................................................................................................................ 25
Immuungemediëerde thrombose .................................................................................... 25
Antifosfolipidensyndroom................................................................................................ 25
Bloedingsziekten en veneuze tromboembolie ....................................................................... 26
Erfelijke en verworven bloedingsneiging ............................................................................. 26
Bloedingsanamnese ......................................................................................................... 27
Aangeboren, familiaal .................................................................................................. 27
Bloedingspatroon ......................................................................................................... 27
Hemofilie A en B ............................................................................................................... 27
Klinisch beeld................................................................................................................ 27
Diagnose: stollingstesten ............................................................................................. 28
Behandeling .................................................................................................................. 28
Andere ziektes .................................................................................................................. 29
factor XI tekort ............................................................................................................. 29
Von Willebrand’s disease ................................................................................................. 29
Fenotypes ..................................................................................................................... 29
Behandeling .................................................................................................................. 29
Verworven bloedingsneiging............................................................................................ 29
Verminderde aanmaak ................................................................................................. 30
Productie abnormale stollingsfactoren ........................................................................ 30
Specifieke inthibitoren van stollingsfactoren .............................................................. 30
DIC: diffuse intravasculaire coagulatie ......................................................................... 30
Chronische arteriële insufficiëntie OL..................................................................................... 30
Inleiding ................................................................................................................................ 30
2
, Etiologie ................................................................................................................................ 31
Prevalentie ....................................................................................................................... 31
Symptomen .......................................................................................................................... 31
Ernst.................................................................................................................................. 31
Stadium IV: ulcera ........................................................................................................ 31
Diabetesvoet ................................................................................................................ 32
Diagnose ............................................................................................................................... 33
Differentiële diagnose .................................................................................................. 33
Prognose ............................................................................................................................... 33
Lokaal................................................................................................................................ 33
Algemeen.......................................................................................................................... 33
Preventie .............................................................................................................................. 34
Schema ............................................................................................................................. 34
Behandeling .......................................................................................................................... 34
Algemene maatregelen .................................................................................................... 34
Huidige aanpak ................................................................................................................. 35
Studies .............................................................................................................................. 35
Compass trial ................................................................................................................ 35
Voyager trial ................................................................................................................. 35
Terugbetalingscriteria ...................................................................................................... 35
Indicaties ...................................................................................................................... 35
Impact ............................................................................................................................... 36
aspirine ......................................................................................................................... 36
Rivaroxaban .................................................................................................................. 36
Statines ......................................................................................................................... 36
Eenvoudige maatregelen ................................................................................................. 36
Casussen ............................................................................................................................... 36
Casus 1 .............................................................................................................................. 36
Casus 2 .............................................................................................................................. 37
Casus 3 .............................................................................................................................. 37
Indicatie heelkundige behandeling ...................................................................................... 37
Patiënt eigen factoren ...................................................................................................... 37
Factoren letsel .................................................................................................................. 37
Chirurgische mogelijkheden ................................................................................................. 38
Endovasculaire technieken .............................................................................................. 38
3
2025
Vaatpathologie
PROF DR FOURNEAU EN PROF DR VERHAMME
JOZEFIEN CEULEMANS
,Semiologie van het arteriële, veneuze en lymfatische stelsel ............................................... 11
Arterieel stelsel .................................................................................................................... 11
Chronische arteriële insufficiëntie onderste ledematen ................................................. 12
Symptomen .................................................................................................................. 12
Acute ischemie ................................................................................................................. 14
Chronische arteriële insufficiëntie van de viscera ........................................................... 14
Arteriële insufficiëntie van de extracraniële vaten .......................................................... 15
Aneurysmatisch lijden ...................................................................................................... 15
Functionele semeiologie: niet-invasief vasculair onderzoek ................................................. 16
Inleiding ................................................................................................................................ 16
Onderzoeken bij perifeer arterieel lijden ............................................................................. 17
Enkel arm index EAI .......................................................................................................... 17
Interpretatie ................................................................................................................. 17
Beperkingen ................................................................................................................. 17
Duplex slagader ................................................................................................................ 18
Transcutane O2-meter ................................................................................................. 18
Onderzoek veneuze insufficiëntie ........................................................................................ 18
Klinsiche verdenkingg veneuze thrombose ..................................................................... 18
Duplex........................................................................................................................... 18
Spataders .......................................................................................................................... 19
Extracraniele vaatpathologie ............................................................................................... 19
Duplex halsslagaders ........................................................................................................ 19
Subclavian steal syndrome ................................................................................................... 19
Vasospastische aandoeningen ............................................................................................. 19
Capillaroscoop .................................................................................................................. 19
Andere aandoeningen ...................................................................................................... 20
Stolling en antistolling ............................................................................................................. 20
Inleiding ................................................................................................................................ 20
Basisprincipes van bloedstolling .......................................................................................... 20
Bloedvatwandbeschadiging ............................................................................................. 20
Bloedingstijd ................................................................................................................. 21
Stollingscascade ............................................................................................................... 21
Onderzoek van bloedstolling................................................................................................ 22
PT ...................................................................................................................................... 22
aPTT .................................................................................................................................. 22
1
, D-dimeren......................................................................................................................... 22
Gespecialiseerde stollingstesten ...................................................................................... 22
Antitrombotica ..................................................................................................................... 22
Antiaggregantia ................................................................................................................ 22
Anticoagulantia ................................................................................................................ 22
VitK antagonisten ......................................................................................................... 23
Heparines: .................................................................................................................... 23
DOACs en NOACs .......................................................................................................... 24
Procedure bij pt met anticoagulatie ............................................................................ 25
Fibrinolytica .................................................................................................................. 25
Complicaties ..................................................................................................................... 25
Verdieping ............................................................................................................................ 25
Immuungemediëerde thrombose .................................................................................... 25
Antifosfolipidensyndroom................................................................................................ 25
Bloedingsziekten en veneuze tromboembolie ....................................................................... 26
Erfelijke en verworven bloedingsneiging ............................................................................. 26
Bloedingsanamnese ......................................................................................................... 27
Aangeboren, familiaal .................................................................................................. 27
Bloedingspatroon ......................................................................................................... 27
Hemofilie A en B ............................................................................................................... 27
Klinisch beeld................................................................................................................ 27
Diagnose: stollingstesten ............................................................................................. 28
Behandeling .................................................................................................................. 28
Andere ziektes .................................................................................................................. 29
factor XI tekort ............................................................................................................. 29
Von Willebrand’s disease ................................................................................................. 29
Fenotypes ..................................................................................................................... 29
Behandeling .................................................................................................................. 29
Verworven bloedingsneiging............................................................................................ 29
Verminderde aanmaak ................................................................................................. 30
Productie abnormale stollingsfactoren ........................................................................ 30
Specifieke inthibitoren van stollingsfactoren .............................................................. 30
DIC: diffuse intravasculaire coagulatie ......................................................................... 30
Chronische arteriële insufficiëntie OL..................................................................................... 30
Inleiding ................................................................................................................................ 30
2
, Etiologie ................................................................................................................................ 31
Prevalentie ....................................................................................................................... 31
Symptomen .......................................................................................................................... 31
Ernst.................................................................................................................................. 31
Stadium IV: ulcera ........................................................................................................ 31
Diabetesvoet ................................................................................................................ 32
Diagnose ............................................................................................................................... 33
Differentiële diagnose .................................................................................................. 33
Prognose ............................................................................................................................... 33
Lokaal................................................................................................................................ 33
Algemeen.......................................................................................................................... 33
Preventie .............................................................................................................................. 34
Schema ............................................................................................................................. 34
Behandeling .......................................................................................................................... 34
Algemene maatregelen .................................................................................................... 34
Huidige aanpak ................................................................................................................. 35
Studies .............................................................................................................................. 35
Compass trial ................................................................................................................ 35
Voyager trial ................................................................................................................. 35
Terugbetalingscriteria ...................................................................................................... 35
Indicaties ...................................................................................................................... 35
Impact ............................................................................................................................... 36
aspirine ......................................................................................................................... 36
Rivaroxaban .................................................................................................................. 36
Statines ......................................................................................................................... 36
Eenvoudige maatregelen ................................................................................................. 36
Casussen ............................................................................................................................... 36
Casus 1 .............................................................................................................................. 36
Casus 2 .............................................................................................................................. 37
Casus 3 .............................................................................................................................. 37
Indicatie heelkundige behandeling ...................................................................................... 37
Patiënt eigen factoren ...................................................................................................... 37
Factoren letsel .................................................................................................................. 37
Chirurgische mogelijkheden ................................................................................................. 38
Endovasculaire technieken .............................................................................................. 38
3
