ACADEMIEJAAR 2021 - 2022
VAATHEELKUNDE
Prof. De hertogh, Prof. D’hoore, prof. Vermeire, prof. Nevens, Prof. Roskams, prof. Tack, prof. Topal, PRof. Van
Cutsem en prof. Verslype
,INHOUDSTAFEL
Inhoudstafel ......................................................................................................................................................1
Hoofdstuk 1 & 2 ................................................................................................................................................3
1.1 Inleiding .............................................................................................................................................3
Hoofdstuk 3 ....................................................................................................................................................10
1.1 Pathogenese ....................................................................................................................................10
1.2 CV risicofactoren ............................................................................................................................10
1.3 Cardiovasculaire preventie .............................................................................................................12
Hoofdstuk 4 ....................................................................................................................................................15
1.1 Inleiding............................................................................................................................................15
1.2 Epidemiologie..................................................................................................................................15
1.3 Pathogenese....................................................................................................................................15
1.4 Symptomatologie............................................................................................................................18
1.5 Diagnose en screening ...................................................................................................................18
1.6 Behandeling.....................................................................................................................................18
Hoofdstuk 5 ....................................................................................................................................................19
1.1 Antiaggregantia ...............................................................................................................................19
1.2 Anticoagulantia ..............................................................................................................................20
1.3 Fibrinolytica ....................................................................................................................................22
Hoofdstuk 7 ....................................................................................................................................................24
1.1 Etiologie ...........................................................................................................................................24
1.2 Aneurysma van abdominale aorta (AAA).......................................................................................25
1.3 Thoracale (Taa) en thoracoabdominale aneurysma (TAAA) ..........................................................27
1.4 Aneurysma’s van andere slagaders................................................................................................28
Hoofdstuk 8....................................................................................................................................................29
1.1 Dissectie van de aorta .....................................................................................................................29
1.2 Viscerale dissectie ..........................................................................................................................32
1.3 Dissectie halsslagaders ..................................................................................................................32
1.4 Intramuraal hematoom en penetrerend ulcus ..............................................................................32
Hoofdstuk 9....................................................................................................................................................33
1.1 Vasospastische aandoeningen .......................................................................................................33
1.2 In lammatoire en dysplastische aandoeningen ............................................................................34
1.3 Neurovasculaire compressie..........................................................................................................36
1.4 Anatomische varianten ..................................................................................................................39
Hoofdstuk 10 ..................................................................................................................................................43
1
, 1.1 Algemeen ........................................................................................................................................43
1.2 Speci ieke letsels............................................................................................................................44
Hoofdstuk 11 ...................................................................................................................................................45
1.1 Oppervlakkige veneuze insu iciëntie - Varices .............................................................................45
1.2 Diepe veneuze insu iciëntie ..........................................................................................................49
Hoofdstuk 12 ..................................................................................................................................................50
1.1 Oppervlakkige trombo lebitis.........................................................................................................50
1.2 DVT...................................................................................................................................................51
1.3 Longembool....................................................................................................................................54
Hoofdstuk 13...................................................................................................................................................57
1.1 Lymfestelsel en pathogenese lymfoedeem....................................................................................57
Hoofdstuk 14 ..................................................................................................................................................60
1.1 Inleiding...........................................................................................................................................60
1.2 Classi icatie ....................................................................................................................................60
1.3 Diagnose.........................................................................................................................................60
1.4 Behandeling ....................................................................................................................................61
1.5 Typische syndromen .......................................................................................................................61
Hoofdstuk 15 ..................................................................................................................................................62
1.1 Vaatacces hemodialyse...................................................................................................................62
1.2 Vaatacces intraveneuze therapie...................................................................................................63
1.3 Arteriële acces................................................................................................................................64
2
, HOOFDSTUK 1 & 2
Anatomie en Semeiologie vaat
1.1 INLEIDING
Functies: - Niet-trombogeen transport bloed
- Stockage bloed
- Regulatie moleculaire + cellulaire verplaatsing tss vaatlumen en extracellulaire ruimte
3 vaatstelsels: - Arterieel stelsel
Grote elastische arteries: kunnen uitzetten en ↑ druk opvangen
Middelgrote musculaire arteries: onderhouden toevoer weefsels
Kleine arteries/arteriolen: perifere weerstand en BD =
Wand van de arteries bestaat uit: 1. Intima
2. Media
3. Adventitia
- Veneus stelsel
Oppervlakkig systeem en diep systeem al dan niet verbonden
Kleppen: 1 stroomrichting
Grotere diameter dan arteries, dunnere wand, minder spiercellen
Functies: - Opslagfunctie → circulerend volume ↓
- Veneuze retour: zwaartekracht
perifere pompwerking + spierkracht
ademhaling
hart: vis-a-tergo e ect: residuele druk
vis-a-fronte e ect: zuigkracht
- Lymfestelsel
Functies: Recupereert eiwitten uit interstitiële ruimte
Verwijderen vreemde partikels
Flow neemt toe bij beweging
Endotheel:
Bescherming trombose: evenwicht anti- en protrombotische sto en
Vaattonus regelen: vasoconstrictie en vasodilatatie (vasoactieve sto en/impulsen)
Herstelt schade endotheellaag: aanmaak en migratie gladde spiercellen
Zie anatomische atlas voor herhaling vaten !!!!
3
VAATHEELKUNDE
Prof. De hertogh, Prof. D’hoore, prof. Vermeire, prof. Nevens, Prof. Roskams, prof. Tack, prof. Topal, PRof. Van
Cutsem en prof. Verslype
,INHOUDSTAFEL
Inhoudstafel ......................................................................................................................................................1
Hoofdstuk 1 & 2 ................................................................................................................................................3
1.1 Inleiding .............................................................................................................................................3
Hoofdstuk 3 ....................................................................................................................................................10
1.1 Pathogenese ....................................................................................................................................10
1.2 CV risicofactoren ............................................................................................................................10
1.3 Cardiovasculaire preventie .............................................................................................................12
Hoofdstuk 4 ....................................................................................................................................................15
1.1 Inleiding............................................................................................................................................15
1.2 Epidemiologie..................................................................................................................................15
1.3 Pathogenese....................................................................................................................................15
1.4 Symptomatologie............................................................................................................................18
1.5 Diagnose en screening ...................................................................................................................18
1.6 Behandeling.....................................................................................................................................18
Hoofdstuk 5 ....................................................................................................................................................19
1.1 Antiaggregantia ...............................................................................................................................19
1.2 Anticoagulantia ..............................................................................................................................20
1.3 Fibrinolytica ....................................................................................................................................22
Hoofdstuk 7 ....................................................................................................................................................24
1.1 Etiologie ...........................................................................................................................................24
1.2 Aneurysma van abdominale aorta (AAA).......................................................................................25
1.3 Thoracale (Taa) en thoracoabdominale aneurysma (TAAA) ..........................................................27
1.4 Aneurysma’s van andere slagaders................................................................................................28
Hoofdstuk 8....................................................................................................................................................29
1.1 Dissectie van de aorta .....................................................................................................................29
1.2 Viscerale dissectie ..........................................................................................................................32
1.3 Dissectie halsslagaders ..................................................................................................................32
1.4 Intramuraal hematoom en penetrerend ulcus ..............................................................................32
Hoofdstuk 9....................................................................................................................................................33
1.1 Vasospastische aandoeningen .......................................................................................................33
1.2 In lammatoire en dysplastische aandoeningen ............................................................................34
1.3 Neurovasculaire compressie..........................................................................................................36
1.4 Anatomische varianten ..................................................................................................................39
Hoofdstuk 10 ..................................................................................................................................................43
1
, 1.1 Algemeen ........................................................................................................................................43
1.2 Speci ieke letsels............................................................................................................................44
Hoofdstuk 11 ...................................................................................................................................................45
1.1 Oppervlakkige veneuze insu iciëntie - Varices .............................................................................45
1.2 Diepe veneuze insu iciëntie ..........................................................................................................49
Hoofdstuk 12 ..................................................................................................................................................50
1.1 Oppervlakkige trombo lebitis.........................................................................................................50
1.2 DVT...................................................................................................................................................51
1.3 Longembool....................................................................................................................................54
Hoofdstuk 13...................................................................................................................................................57
1.1 Lymfestelsel en pathogenese lymfoedeem....................................................................................57
Hoofdstuk 14 ..................................................................................................................................................60
1.1 Inleiding...........................................................................................................................................60
1.2 Classi icatie ....................................................................................................................................60
1.3 Diagnose.........................................................................................................................................60
1.4 Behandeling ....................................................................................................................................61
1.5 Typische syndromen .......................................................................................................................61
Hoofdstuk 15 ..................................................................................................................................................62
1.1 Vaatacces hemodialyse...................................................................................................................62
1.2 Vaatacces intraveneuze therapie...................................................................................................63
1.3 Arteriële acces................................................................................................................................64
2
, HOOFDSTUK 1 & 2
Anatomie en Semeiologie vaat
1.1 INLEIDING
Functies: - Niet-trombogeen transport bloed
- Stockage bloed
- Regulatie moleculaire + cellulaire verplaatsing tss vaatlumen en extracellulaire ruimte
3 vaatstelsels: - Arterieel stelsel
Grote elastische arteries: kunnen uitzetten en ↑ druk opvangen
Middelgrote musculaire arteries: onderhouden toevoer weefsels
Kleine arteries/arteriolen: perifere weerstand en BD =
Wand van de arteries bestaat uit: 1. Intima
2. Media
3. Adventitia
- Veneus stelsel
Oppervlakkig systeem en diep systeem al dan niet verbonden
Kleppen: 1 stroomrichting
Grotere diameter dan arteries, dunnere wand, minder spiercellen
Functies: - Opslagfunctie → circulerend volume ↓
- Veneuze retour: zwaartekracht
perifere pompwerking + spierkracht
ademhaling
hart: vis-a-tergo e ect: residuele druk
vis-a-fronte e ect: zuigkracht
- Lymfestelsel
Functies: Recupereert eiwitten uit interstitiële ruimte
Verwijderen vreemde partikels
Flow neemt toe bij beweging
Endotheel:
Bescherming trombose: evenwicht anti- en protrombotische sto en
Vaattonus regelen: vasoconstrictie en vasodilatatie (vasoactieve sto en/impulsen)
Herstelt schade endotheellaag: aanmaak en migratie gladde spiercellen
Zie anatomische atlas voor herhaling vaten !!!!
3
