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Acute Arterial Obstruction


This is defined as sudden cessation of blood flow in the main artery as a result of thrombosis, embolism, spasm, injury etc…
Causes of thrombosis
( Virchow triad:
§  the predominance of the coagulation system
§  damage to the vascular wall
§  Turbulent blood flow
( Diseases leading to thrombosis:
§  Atherosclerosis.
§  Occlusive disease.
§  Nonspecific aorto-arteritis.
Embologenic disease - the state of the body leading to the occurrence of embolism 
®  Cardiac (95%):
®  CHD (50%) - myocardial infarction, rhythm abnormalities (atrial fibrillation, arrhythmia et al.), Heart aneurysm.
®  Heart disease (40%).
®  Myocarditis, endocarditis, pneumonia (5%)
®  Noncardia (5%) - vascular aneurysm.
Pathogenesis of acute ischemia
®  Closing of the main artery.
®  Peripheral arterial spasm.
®  Blood stasis.
®  Continued thrombosis - upward and downward with respect to the place of the initial blockage.
®  The development of inflammatory reactions of the vascular wall.
®  The development of venous thrombosis.
®  Tissue hypoxia, metabolic acidosis.
®  Hyperkalemia, "myoglobinuria nephrosis".
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Classification of acute arterial obstruction of VS Savelyev (1974).

®  1A - paresthesia, numbness, coldness.
®  1B - pain.
®  2A - paresis.
®  2B - plegia.
®  2B - subfascial edema.
®  3A - partial muscle contraction.
®  3B - total muscle contracture.

Diagnosis of acute ischemia
®  Complaints and medical history of the patient.
®  An objective examination of the patient.
®  Coating of the skin temperature.
®  The study of the motor activity and sensitivity of the patient.
®  Palpation and auscultation of the vessels.
®  Symptom "grooves."
®  Ultrasonic methods of research.
®  Angiography.

 Treatment Prehospital
®  Antispasmodics - no-spa, papaverine, to relieve spasm of the peripheral channel.
®  Analgesics - narcotic or narcotic analgesics.
®  Anticoagulant direct action - heparin 10,000 units, in order to prevent further thrombosis
®  Hospitalization in a specialized department for treatment.
Indications for angiography:
®  When unclear clinical disease.
®  At discrepancy pulsation level to the border of ischemia tissue.
®  In order to differentiate between the different types of arterial obstruction.
®  In the case of multiple, multi-storey and co thromboembolism.
®  At the big diseases ago.
®  After surgery, if the ischemia persists.

Tactics of treatment justified:
®  Disease duration.
®  Localization of the lesion.
®  The degree of limb ischemia.
®  General condition of the patient.
Reconstructive surgery is not shown:
(( ischemia III degree.
In patients with agonal condition 
( ischemia IA and IB Art. and severe general condition of the patient initially given conservative treatment.



 Alternative notes
Peripheral Arterial Disease (Arterial insufficiency)
Divided into acute and chronic
acute
chronic
Thrombosis
Raynaud's disease
Embolism
occlusive disease
Thromboangiitis obliterans (Buerger's disease)
atherosclerosis
diabetic angiopathy

Thrombosis
Virchow triad
Embolism
  • damage the vessel wall;
  • changes in the blood;
  • blood flow disorders.
Detachment of the thrombus from the aorta or the left half of the heart.
Against the background of chronic occlusive arterial disease.
Against the background of diseases of the heart, the aorta (aortic aneurysm, valvular heart disease, endocarditis, atherosclerotic cardio).

Classification of Acute arterial insufficiency
1a stage
Numbness, coldness
step 1b
Pain syndrome
step 2A
Violation sensitivity and active movements
stage 2b
plegia limbs
step 3a
Subfascial edema
stage 3b
contracture

Thrombosis. Embolism arteries. Surgery.
Thrombectomy and embolectomy (to step 2b)
Direct (open) - with the opening of the lumen - arteriotomy
Indirect (closed) - balloon catheter
Reconstructive surgery (carotid endarterectomy, bypass surgery, prosthesis) in chronic occlusive arterial diseases.

Thrombosis. Embolism arteries.
Conservative treatment.

  • Removing spasm and pain;
  • Heparin to 40.000-50.000 IU daily subcutaneously every 4 hour or intravenously controlled SSC;
  • Thrombolytic therapy in the first 6-8 hours:
-        Plasmin to 60.000-10.0000 IU per day;
-        Streptokinase to 1,500,000 units per day;
-        Urokinase to 800,000 units per day.
  • Rheological Properties of improvement in blood and metabolic processes in the tissues:
-        reopoligljukin;
-        trental;
-        A nicotinic acid;
-        Vazaprostan.

Raynaud's disease. Differential diagnosis.
  • Compression of the subclavian artery:
-        An additional cervical rib;
-        The first rib;
-        Hypertrophic anterior scalene muscle;
-        Hypertrophic pectoralis minor muscle.
  • Osteochondrosis of the cervical, thoracic spine;
  • thyroid disease;
  • Psychoneuroses.

occlusive disease
Clinical
  • Pain syndrome;
  • Coldness, numbness in feet;
  • Pallor, cyanosis of the skin;
  • Trophic ulcer;
  • Dry gangrene;
  • Wet gangrene.
Diagnostics:
-        These clinical findings;
-        Ultrasound diagnostics;
-        arteriography;
-        Rheovasography.
Treatment:
  1. Surgery - reconstructive surgery, sympathectomy;
  2. conservative:
-      antispasmodics;
-      trental;
-      tanakan;
-      solkoseril;
-      reopoligljukin;
-      A nicotinic acid.

Thromboangiitis (Winiwarter-Buerger's disease)

Inflammation of the arteries and veins - combination obliterating endarteritis and thrombophlebitis (floating) superficial veins. Often complicated by gangrene of the extremities.
Diagnostics:
-        Clinical examination;
-        rheovasography;
-        Ultrasound diagnostics;
-        Arteriography.
Treatment:
  1. Conservative therapy - antispasmodic, anti-inflammatory therapy, desagregants prednisolone.
  2. Surgical treatment - bypass surgery, lumbar sympathectomy. 
Atherosclerosis
The defeat of the inner lining of artery - the intima due to the formation of atherosclerotic plaques.
-        Men often suffer from;
-        Age after age 40;
-        Combined with the sclerosis of the vessels of the heart and brain.
Risk factors:
-        Smoking;
-        Disorders of lipid metabolism;
-        Arterial hypertension;
-        Diabetes;
-        lack of exercise;
-        Burdened heredity.
 3 main disorders:
-        Lipid metabolism (hypercholesterolemia, atherosclerotic plaques narrows the lumen of the arteries);
-        Resizing structure and metabolism in the vascular wall;
-        Violation of coagulation and anticoagulative systems.
symptoms:
-        Pain in the legs when walking "intermittent claudication";
-        Numbness, cold feet;
-        Reduction of hair;
-        Dystrophy
-        nail plate;
-        Trophic ulcers;
-        Dry gangrene;
-        Wet gangrene.

The symptoms of chronic arterial insufficiency

Symptom of plantar ischemia Oppel - skin blanching when picked up feet.
Panchenko symptom - pain when crossed legs.
Goldflama symptom - fatigue during flexion of the foot.
Symptom Samuels - skin blanching with flexion of the foot.
The symptom of "white spots" - at a pressure on the plantar surface of the I-th toe remains a white spot (normally 5-10 seconds normal coloring.).
Changing the color of the skin, depending on the position of the lower limbs -. In the supine position to raise the legs, appearance of skin pallor stop after 1 min, lowered down the legs appears bright red color stop.













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