Occlusion of arteries

Description:

Acute occlusions of arteries — an acute disorder of blood circulation distalny places of occlusion of an artery an embolus or blood clot. The state is considered urgent. Proksimalny and distalny the site of occlusion the normal blood flow is broken that leads to an additional thrombogenesis. Process can take collaterals, spread of blood clot up to venous system is possible. The state is considered reversible during 4–6 h from its beginning (in English-speaking literature this time interval is called "the gold period"). After this time deep ischemia leads to irreversible necrotic changes.
Frequency of hospitalization — 5–10:10 000 population. The leading cause of death and losses of extremities at advanced age. The prevailing age — is more senior than 60 years. The prevailing floor — men's.

Symptoms of Occlusion of arteries:

Five main symptoms — in English-speaking literature a symptom complex of "five P". (If there is at least one of these signs, planned inspection for the purpose of identification of occlusion is shown. Occlusion of the vessels located more proksimalno leads to more bystry progressing of symptoms. Occlusion at the level of bifurcation of an aorta can cause defeat symptoms on both sides.).
Pain — is localized distalny places of occlusion, diffuse, gradually amplifies (sometimes at spontaneous permission of occlusion disappears). Most often — the first symptom of an embolism. It is not facilitated at change of position of an extremity.
Lack of pulse (Pulselessness) — is obligatory for the diagnosis of an embolism or thrombosis. Doctors often have no skill of definition of pulse on a. dorsalis pedis that conducts to diagnostic mistakes. When determining pulse it is necessary to compare it on both extremities.
Pallor — skin color at first pale, then arises cyanosis. Temperature of an extremity should be checked consistently from top to down. Existence of symptoms of chronic ischemia (a skin atrophy [dryness, rugosity, a peeling], lack of hair, a thickening and fragility of nails) is possible.
Paresthesia — numbness, feeling of a pricking, crawling of "goosebumps" appear at early stages of thrombosis. In the beginning tactile sensitivity (feeling of a touch) disappears. At SD tactile sensitivity can be initially reduced. Disappearance of painful and deep sensitivity indicates the expressed ischemia.
Paralysis — motive function is broken at late stages and indicates deep ischemia.

Reasons of Occlusion of arteries:

Artery embolism — vessel obturation the embolus migrating on a blood flow. Embolisms classify depending on primary source of defeat. A source — the left half of heart:
- Pristenochny blood clot as a result of arrhythmia, a heart attack, a surgical injury, a stenosis of the mitral valve, an endocarditis and cordial weakness of any etiology.
- Vegetations on valves
- Foreign bodys
- Tumors
Source — an aorta:
- Sclerous plaques
- An injury with the subsequent thrombosis
- Aneurism
- Foreign bodys
Source — pulmonary veins:
- Thrombosis
- An injury with the subsequent thrombosis
- Tumors
Source — the right heart: at defects of interventricular and interatrial partitions.
Source — veins of a big circle of blood circulation: at defects of interventricular and interatrial partitions.
- Artherothrombosis. Pathogenetic triad of Virkhov: damages of a vascular wall, change of composition of blood, disturbance of a blood-groove (its laminar current)
- Damages of a vascular wall
- Obliterating atherosclerosis
- Arteritis: system allergic vasculites (the obliterating thromboangitis, nonspecific aortoarteriit, a nodular periarteritis), infectious arteritis
- Injury
- Iatrogenic damages of vessels
- Other (at freezing injury, influence of electric current, etc.).
Blood diseases: Osler's disease, leukoses;
Diseases of internals (atherosclerosis, hypertension, malignant tumors, etc.).
Disturbances of a blood-groove:
- Ekstravazalny compression
- Aneurism
- Spasm
- Acute circulatory unefficiency, collapse
- The previous artery operation.

Treatment of Occlusion of arteries:

The mode is stationary.
Tactics of treatment depends on ischemia degree.
Ischemia of tension and IA of degree — it is possible to be limited to conservative treatment. In the absence of effect during 24 h at the patient with an embolism of a vessel or during 7 days at the patient with thrombosis organ-preserving surgery  Ischemia of IB-IIB of degrees — the immediate surgery directed to recovery of a blood-groove is necessary (blood clot - or an embolectomy, reconstructive operation of bypass shunting).
Ischemia of IIIA-IIIB of degrees — emergency blood clot - or the embolectomy, bypass shunting which are surely added with a fasciotomy. In certain cases operation is accompanied with partial perfusion of an extremity.
Ischemia of IIIB of degree — primary amputation of the affected extremity since recovery of a blood-groove can lead to an endointoxication and death of the patient.