Otitis

Vascular obstruction. Acute arterial obstruction of the lower extremities

The performance, intelligence, and mental activity of a person depend on the condition of the blood vessels. Blockage of blood vessels in the brain is accompanied by deterioration of blood circulation in the brain, insufficient supply of oxygen and nutrients, which can lead to serious consequences in the future.

What is the danger of blockage of blood vessels?

Blockage of blood vessels in the brain caused by the accumulation of air bubbles, fat, or a blood clot is called an embolism.. Penetrating into arteries with a narrow lumen, the particles provoke their blockage, disrupting blood flow and causing tissue destruction from lack of oxygen.

If left untreated, the pathology can cause:

cerebral infarction;
thrombus formation;
cerebral hemorrhage;
dementia.

The pathology is most often observed in the elderly, but it can also occur in young people under the influence of unfavorable factors.

Symptoms

The cerebral circulatory disorder is initially asymptomatic. However, there are some signals indicating the development of pathology.

Common symptoms of vascular diseases include:

tendency to frequent dizziness and fainting;
sleep disorder;
headaches, migraine attacks;
memory impairment;
fatigue;
numbness of hands and feet;
deterioration of coordination;
mood variability.

After this, other signs may be added:

gait disturbance: the person may shuffle or mince;
noise in ears;
visual impairment;
prolonged migraines;
false need to urinate.

Lack of therapy leads to progression of the disease and the appearance of new symptoms:

noticeable loss of coordination of movements;
deterioration of intellectual abilities;
various disorders of the urinary system.

Severe cases of arterial blockage often result in complete immobility and death..

In the advanced stage, systematic medical care is required: the patient may lose control of his actions and become incapacitated.

Causes

Chronic blockage of the lumen of blood vessels, impeding blood flow, can occur as a result of injuries, atherosclerosis, as well as various diseases: diabetes, high blood pressure, vasculitis.

Other reasons for the development of pathology include:

lack of physical activity;
genetic predisposition;
chronic stress;
negative habits: excessive drinking, smoking;
poor nutrition.

Eating fatty foods and foods containing additives leads to the accumulation of cholesterol in the arteries, which, in turn, is a prerequisite for the development of atherosclerosis.

Diagnostics

A neurologist will help identify the pathology, who will assess the neurological symptoms, mental abilities of the patient, as well as the degree of manifestation of reflexes. However, to make an accurate diagnosis, the following studies will be required:

ultrasound diagnostics;
computed tomography;
angiography;
electroencephalography.

These methods will help determine the condition of the brain, the size and location of lesions and the nature of the disease.

Treatment

Treatment of the disease depends on the clinical picture and form of pathology. In case of exacerbation, the use of medications will be required to help reduce symptoms and improve cerebral circulation.

Most often, an integrated approach is used, including the use of medications, adjustments to diet and lifestyle, as well as alternative medicine recipes. Some cases require surgery.

Medicines

The most commonly used drugs are:

statins - medications that reduce cholesterol production, for example, simvastatin, zocor;
fibrates – medications that prevent atherosclerotic plaques, lipanor, fenofibrate;
papaverine and aminophylline are used to dilate cerebral blood vessels;
to strengthen the immune system, antioxidants and vitamin-mineral complexes are prescribed;
Cavinton and Vasobral are used to improve blood circulation in the brain.

The duration and dose of medication use is determined by the attending physician. In some cases, the patient has to take medications for the rest of his life.

However, no medicine will have the desired effect without following a balanced diet.

exclude animal fats and smoked meats;
give up fried foods, spicy salty foods, fast food;
limit the consumption of sweets and soda;
enrich the diet with vegetables, fruits, and seafood.

In addition, you need to monitor your body weight, give up negative habits, walk more often and exercise.

ethnoscience

You can clear arteries of harmful deposits using folk remedies. Home remedies for blockage treatment are used as adjuvant therapy..

In acute or advanced stages of the disease, alternative medicine may become useless.

Rose hip

Rosehip infusion showed excellent results in eliminating vascular obstruction in the brain.. To prepare, you will need to leave 50 g of fruit for 6 hours. Take a decoction of 200 g, several times a day, for a month.

Hawthorn

The fruits are poured into 500 g of boiling water, boiled, honey is added to the drink and consumed 20 g before meals, twice a day.

This folk remedy helps remove cholesterol plaques from the arteries and strengthen the walls..

To prepare, you will need 200 g of nut partitions and the same amount of vodka.

The infusion is kept for 14 days in a dark place.

Take 20 drops of the product, diluting it with 50 g of water, three times a day, for half a month.

Sea buckthorn oil

Daily consumption of 1 teaspoon of oil before meals will help improve the blood vessels of the head. The course of therapy is 21 days. After a break of 1 month, treatment is repeated.

Garlic

Garlic is an excellent natural remedy for preventing colds. Beneficial properties allow it to be used to cleanse vascular walls of cholesterol.:

To prepare, several cloves of garlic are crushed in a meat grinder, poured with alcohol and left in a dark place for 10 days. Strain the composition and take 20 drops, diluted with 100 g of water, half an hour before meals, three times a day. The course of treatment is 30 days. This remedy will help cleanse the arteries and remove cholesterol deposits.
Peeled heads of garlic are placed in 200 g of milk. The mixture is boiled until the garlic softens. The milk is drained and taken 1 tablespoon three times a day.
The following recipe will help to effectively cleanse the vascular walls. To prepare, you will need 1 head of garlic and 1 lemon in peel. Grind the ingredients with a meat grinder, add 1 liter of water, infuse and consume 50 g three times a day for 1 month. The course of therapy is twice a year. This remedy will help stabilize blood pressure and strengthen the immune system.

Drinking freshly squeezed juices from celery, tomato, carrots and pomegranate will be beneficial for blood vessels.

To prevent blockage of blood vessels, it is necessary to maintain a healthy lifestyle, eat rationally, not neglect regular physical activity, and also systematically undergo a medical examination. This is especially true for people at risk.

Today, diseases of the cardiovascular system are not so rare. Occlusion of the arteries of the lower extremities often occurs, which is a narrowing of the lumen between the walls of the vessels. Sometimes this process contributes to complete blockage of the veins, and then the disease is very difficult to cure. Since this disease is difficult to treat, experts recommend taking regular preventive measures and immediately starting treatment when the first symptoms of such a disease appear.

Causes of pathology

Experienced doctors say that vascular occlusion of the lower extremities can occur due to blood flow disturbances. Most often, blood obstruction is fixed in the femoral artery. The disease develops gradually over a long period of time.

Typically, professionals associate it with some specific complications. An example of this would be thromboembolism. Moreover, almost 90% of all cases are associated with blood clot problems. The basis for the appearance of occlusion may be atherosclerosis and blockage of blood vessels by cholesterol plaques.

Vascular obstruction is often observed during embolism. This is the so-called blockage of blood vessels with gases and other vessels. Similar problems can arise due to incorrect placement of an IV or taking a blood test from a vein.

Often, mechanical damage to the veins can become a condition for the appearance of this disease. In this case, the gaps are closed by adipose tissue, which eventually closes the entire vessel. This condition is especially dangerous when the popliteal artery is blocked.

The inflammatory process in the body can also contribute to the appearance of occlusion.

As a result, an infection enters the body, which creates this problem in the body.

Lower extremity occlusion can occur due to severe frostbite of the lower extremities, abnormal blood pressure readings, and even complications after surgery.

What symptoms accompany the disease at different stages?

The symptom of occlusion depends, first of all, on the stage of the disease that is observed in the patient. Experts in the field of medicine distinguish 4 main stages of occlusion of the lower extremities.

At the first stage, a person may feel slight fatigue, which occurs as a result of prolonged walking. After serious physical exertion, such patients usually have lighter skin, and sometimes even too white. It is this symptom that should prompt a person to consult a specialist, especially if this phenomenon occurs with a certain regularity.
At the second stage, the legs begin to hurt severely, even if the person does not put any weight on the limbs. Sometimes it gets to the point where a slight lameness develops. This is also a sign that it is time to seek advice from a specialist.
At the next stage, pain is observed even when the person is at rest. They become so unbearable that some patients resort to self-medication.
At the last stage, vascular disease is visible to the naked eye. Sores appear on the skin of the legs, which constantly grow in size and hurt unbearably. In particularly advanced conditions, it sometimes leads to the appearance of gangrene.

At all stages of the disease it has its own visual manifestations. For example, blue discoloration of the skin or darkening of blood vessels.

How is the presence of occlusion determined?

If a patient feels severe pain when walking and not only notices changes in skin tone after exercise, he should urgently seek help from a specialist who treats cardiovascular diseases. Only a true professional can confirm or deny that this is an occlusion of the lower extremities, and the person needs immediate treatment. After an examination, the doctor will definitely prescribe a suitable treatment program that will help get rid of the disease.

Diagnostics involves several studies by a specialist. As soon as a person contacts the appropriate doctor, he immediately conducts a visual examination. It involves assessing the shade of the lower extremities, feeling them, etc.

If the doctor determines that this may indeed be an occlusion, the patient is prescribed a scan of the arteries of the lower extremities, treatment of which will still be prescribed, regardless of the disease. During this procedure, the specialist must determine the specific location of the blockage.

After this, the doctor must calculate the so-called ankle-brachial index. They will allow you to make more accurate conclusions about the speed of blood flow and, accordingly, prescribe the correct treatment.

The easiest way to identify the problem is MSCT angiography. This procedure allows you to assess the condition of the blood vessels and its deviation from the norm.

The set of diagnostic procedures depends on the stage of the disease, the speed of its progress and the professionalism of your attending physician.

What should be the treatment?

Occlusion of the lower extremities can be treated only by following the recommendations of your doctor. This is usually done by a vascular surgeon. The features of the procedures, their frequency and quantity are determined by the stage of inflammation at the time the patient contacts the doctor.

At the first stage, when the disease is just beginning to progress, the most conservative treatment methods are prescribed.

In this case, the patient is prescribed special medications that eliminate blockage of blood vessels. After a certain time, blood supply improves. Often, for a faster effect, additional physiotherapeutic procedures are prescribed, which help restore the walls of blood vessels and also accelerate the appearance of positive effects.

Already at the second stage, the patient needs immediate surgical intervention. In this case, the surgeon removes the largest blood clots that cannot be treated with medication.

At the last stage, surgical intervention is prescribed not just to remove blood clots, but also to eliminate dead tissue. In parallel with this, the patient undergoes special therapy, which serves as a good therapeutic prophylaxis.

Occlusion is a dangerous disease that develops very quickly, but requires long-term treatment. That is why it is better to treat the disease early and turn to specialists for help in a timely manner.

In contact with

Blood vessels in the human body are the most important link in maintaining the vital functions of all internal organs. It is through them that blood flows to the cells of the body with the necessary energy substrates, which take part in the necessary biochemical processes. But due to many external and internal factors, the lumen of the vessel can be obliterated (clogged) from the inside, as a result of which the corresponding organs do not receive proper nutrition, and the cells can die, leading to the loss of the organ’s functions.

Let's consider for what reasons and what usually “clogs” human blood vessels – arteries and veins.

Why does blockage of blood vessels occur?

Obliteration of the vascular lumen can occur as in arterial, and in venous bed. The mechanisms that contribute to blockage of an artery or vein include two main ones: education and formation:

Blood clots can clog both types of vessels - veins and arteries, but initially form primarily in the veins.
Atherosclerotic plaques, in turn, “grow” only on the walls of the arteries. However, like blood clots, when they break off, they can migrate through the bloodstream.
In many cases, when we are talking about blockages of blood vessels of “serious” localizations (blockage of blood vessels of the heart, brain), the genesis is mixed - atherothrombotic. The atherosclerotic plaque does not allow the “microthrombus” to pass through and the substrate of atherothrombosis grows from two components like a snowball.
In relatively rare cases, blockage of blood vessels can occur through other mechanisms - fat, body tissue, microbes. About it - .

The first group of causes in most cases (except for local thrombosis of the leg veins) includes thromboembolic conditions, that is, the formation of a blood clot in the lumen of the vessel and its further migration through the bloodstream. Mainly affected are the pulmonary artery system, the coronary arteries (the heart's own vessels), the arteries of the brain, the veins of the lower extremities, as well as the mesenteric arteries in the abdominal cavity, which supply blood to the small and large intestines. Most often, blood clots form in the lumen of the deep and superficial veins of the leg and thigh, and when it is unstablely fixed to the wall of the vein, the blood clot breaks off and further spreads to the right side of the heart and into the pulmonary artery. If a thrombus forms in one of the left chambers of the heart (mural thrombus), it can enter the cerebral arteries with the development of ischemic stroke, into the coronary artery system with the development of acute myocardial infarction, or into the mesenteric arteries with the development of mesenteric thrombosis.

a) blockage of a vessel with a thrombus and thromboembolism using the example of leg veins

The second group of causes includes a pathological process characterized by the formation and fixation of plaques consisting of a core and a tegmentum on the inner wall of arteries. The core contains excess cholesterol, and microthrombi can settle on the tire. In addition to the fact that the plaque itself causes a narrowing of the vessel from the inside, it can destabilize, and atherothrombotic masses will also spread through the bloodstream until they obliterate any artery. More often, the arteries of the brain, coronary arteries, and arteries of the lower extremities are susceptible to plaque formation.

How does vascular blockage manifest?

The clinical picture of obliteration of the vascular lumen is characterized by a wide variety of symptoms. First of all, it depends on whether the process has developed acutely or has been ongoing for a long time. In addition, the localization of obliteration plays an important role in the clinic.

The most common form of vascular blockage is thrombosis of the veins of the lower extremities. The insidious thing is that the disease can be completely asymptomatic and be an invisible companion to venous stagnation and insufficiency. The picture of the acute form can also be colorful - the patient begins to feel pain, the limb changes color, and swelling develops.

acute blockage of the deep veins of the legs

And, for example, with blockage of the arteries of the lower extremities, caused by obliterating atherosclerosis, the pathognomonic symptom is intermittent claudication, when, due to the load (walking), the need for oxygen in the skeletal muscles of the leg increases, and the obliterated arteries cannot satisfy this need. After a certain number of steps, the patient experiences dull or sharp pain in his legs, which is why he is forced to constantly stop.

blockage of leg arteries with plaque due to atherosclerosis

When the lumen of the coronary arteries of the heart is obliterated, the clinical picture will depend on the percentage by which the lumen of the artery is blocked from the inside. When the blockage of the heart vessels is less than 50%, the patient will experience rare attacks of chest pain of the type , and with significant stenosis (70-90% or more) it is likely to develop acute with sharp chest pain, relieved only by the administration of narcotic analgesics, as well as with a general serious condition patient. Some patients may develop a painless or atypical form of acute myocardial infarction.

Long-term, but not critical, obliteration of cerebral vessels leads to development. Usually, when confirmed, the doctor mentions the presence of encephalopathy of atherosclerotic origin in the patient. This pathology usually occurs in older people and is manifested by mood swings, tearfulness, touchiness, decreased memory and cognitive (thought) processes. Long-term blockage of blood vessels in the brain leads to a decrease in intelligence up to senile dementia.

Acute blockage of the cerebral arteries provokes the development of acute. Again, depending on the location of the stroke, the patient experiences symptoms of varying severity - from mild speech impairment (dysarthria) and slight facial asymmetry to severe paralysis of the limbs (para- and tetraparesis), often with impaired swallowing and respiratory functions.

Blockage of mesenteric vessels thrombus is a severe surgical pathology requiring urgent surgical intervention, since the lack of blood supply in the mesentery leads to the development of subsequent peritonitis and sepsis (blood poisoning). It manifests itself as acute abdominal pain, nausea, vomiting and the rapid onset of peritoneal symptoms (symptoms of peritoneal irritation, indicating the development of peritonitis).

How is vascular blockage diagnosed?

Due to the fact that blockage of a vessel of any location is a potentially dangerous condition that requires timely assistance, a doctor of any specialty must know which diagnostic methods can be used to confirm or exclude signs of vessel obliteration.

In order to visualize the affected vessel, ultrasound diagnostics is used, in particular. Such methods make it possible to reliably assess the affected area of an artery or vein, as well as assess the patency of a blood vessel and the degree of blood flow disturbance. Doppler ultrasound is used to diagnose blockage of blood vessels in the legs, as well as in the case of atherosclerosis of the carotid arteries that supply the brain.

In case of suspected blockage of the heart vessels, it is carried out with the introduction of an X-ray contrast agent into the lumen of the coronary arteries and subsequent examination of the resulting images.

With the development of acute blockage of cerebral vessels, or the brain is used to visualize the developed stroke.

How to treat blockage of blood vessels?

Treatment tactics for vascular blockage depend on the type and location of the lesion. Thus, in case of thrombosis, it is necessary to “dissolve” the blood clot, for which direct (heparin) or (streptokinase, alteplase, etc.) are successfully used. This treatment regimen is indicated for acute myocardial infarction caused by blockage of the heart vessels. Therapy for long-term coronary artery stenosis involves the use of drugs that dilate the arteries, as well as constant use - in particular, drugs based on acetylsalicylic acid to prevent increased thrombus formation (aspirin, ThromboAss, acecardol, aspirin-Cardio, etc.). If complications develop, the patient is prescribed tablet forms of indirect anticoagulants (farvarin, phenylin, neodicoumarin, etc.) for a long period of time. The most common modern drugs are Xarelto and Pradaxa.

For blockage of the veins of the lower extremities, they are used on the basis of heparin (heparin ointment, Lyoton and hepatrombin gels), in tablets - for example, “Phlebodia”, as well as elastic bandaging of the thighs and legs or wearing (stockings and knee socks).

Obliterating atherosclerosis of the lower extremities is treated with vasodilating (nifedipine, amlodipine) and lipid-lowering drugs - statins (atorvastatin, simvastatin, etc.).

If a patient develops acute blockage of cerebral vessels, the treatment strategy consists of treating ischemic stroke using intravenous administration of appropriate drugs. Chronic encephalopathy of atherosclerotic nature is treated with a course of nootropic and antihypoxic drugs (piracetam, actovegin, mildronate, etc.).

In some cases, a patient with vascular blockage may require surgical treatment - coronary artery bypass grafting (CABG) and stenting for angina pectoris and heart attack, lower extremities, installation in the lumen of the inferior vena cava to prevent the migration of a blood clot along the venous bed, etc.

Are there possible complications of vascular blockage?

Obliteration of a vessel of any location can cause significant harm to human health, since in the absence of blood supply, ischemia and hypoxia of the organ develops, as a result of which the cells die - necrosis develops. Similar pathological processes in the lower extremities can lead to amputation of the limb, and in the vessels of the heart, brain or mesentery - to the patient's death. But with timely detection of embolism and obliteration, as well as with successful treatment, the risk of complications can be minimized, while the quality of life and its duration will undoubtedly increase.

“Occlusion” is a term that is used in various medical fields when it is necessary to designate processes associated with obstruction of patency. If we talk about blockage of blood vessels, then this is a disease that is accompanied by unexpected pain, bleeding of the skin, and obstruction of blood into the limb. Depending on the severity of the disease, different treatment methods are used, including amputation.

What is occlusion?

Vascular occlusion is a disease characterized by the unexpected development of a blood clot or arterial embolism. There is a violation of blood circulation in the limb, as a result of which the patient experiences unpleasant or painful sensations. In some cases, the limb is paralyzed.

The disease most often affects the limbs, but can affect the blood vessels of the heart and brain. Most often, blockages occur in areas of narrowing or branching of blood vessels.

Occlusion of the arteries of the lower extremities is the obstruction of blood through the vessels, which is characterized by suddenness. This condition is considered an emergency and requires immediate hospitalization of the patient.

Causes of blockage of blood vessels

At risk are older people who have suffered from a number of cardiovascular diseases or are predisposed to the formation of blood clots. Most often, the disease affects men over 60 years of age.

The disease can develop against the background of myocardial infarction, arrhythmia, coronary artery disease, heart disease and a number of other diseases.

The most common cause of occlusion is thromboembolism. This means that fatty, tissue, microbial or other fragments that move through the blood clog the vessel, preventing the blood from moving further.

Rare causes include surgical interventions on blood vessels or arteries, trauma, vascular spasms, leukemia, polycythemia, and frostbite.

Blockage of blood vessels can occur due to air entering the vein, which happens, for example, after an unsuccessful injection.

Abuse of alcohol and nicotine thickens the blood and provokes the development of blood clots. Poor nutrition, insufficient physical activity, and low intake of vitamins contribute to the development of the disease.

Vascular occlusion can develop due to disorders of the central nervous system caused by constant stress and overexertion.

Symptoms and diagnosis of pathology

The main symptoms include:

Sudden pain at the site of blockage of blood vessels. This symptom appears in 80% of cases, but sometimes the pain may be minimal or not bother the patient at all. The pain is not localized to one area, but is diffuse. The sensations do not subside, even if you change the position of the limb, and after taking painkillers.
Absence of pulsation at the site of occlusion of the arteries of the lower extremities (the same applies to the upper parts of the body). The doctor checks this sign first when examining the patient.
Pallor of the limb, loss of tactile sensations. After which a loss of muscle strength develops, tingling and goosebumps are felt in the limbs. The last stage is numbness of the limb, the patient cannot feel the arm or leg, which indicates a severe development of the disease.
A sharp decrease in the temperature of the limb despite the fact that the general body temperature is within normal limits.
Sometimes the formation of wrinkles, dry skin, brittle nails, and hair loss are signals for the development of the disease.

If you notice any of the signs of the disease, you should immediately consult a doctor. Time plays a major role in the treatment of this disease. If help is not provided, then 4-6 hours after the first symptom appears, the limb will be amputated.

The first thing a doctor checks when examining a patient is the pulsation of the artery. In addition, there are special diagnostic procedures. For example, the Delbe-Perthes march test, knee phenomenon (Panchenko test), and determination of the zone of reactive hyperemia (Moshkovich test) are indicated. The final diagnosis can be made by instrumental diagnostics - CT, MRI. After the data obtained, treatment tactics are determined.

Depending on the indications, there are 3 stages of disease development, which are taken into account when choosing a method of therapy. At the last stage, an operation to amputate the limb is performed; at the first two, part of the body can still be saved.

Treatment of occlusion

Vascular occlusion is treated as prescribed by a doctor; you cannot treat the disease yourself; there is a risk of losing a limb without the necessary medical care.

At the first stage of the disease, drug therapy is carried out, based on intravenous administration of medications (Heparin, Fibrinolysin, etc.). Medicines help restore blood flow and clear blockages.

In some cases, physiotherapeutic procedures are prescribed.

If the patient’s condition does not improve within a day, then the vascular surgeon performs an operation to eliminate the occlusion - thromboembolectomy.

More severe stages require emergency surgery. The last stage does not include restoration of the limb; amputation occurs. Otherwise, post-ischemic syndrome may develop, which leads to the death of the patient.

After treatment, a course of postoperative therapy is continued to avoid relapse of the disease.

Prognosis and prevention

First of all, patients should not neglect consulting a doctor. Prevention consists of timely treatment of diseases that provoke blockage of blood vessels. It is also necessary to control blood pressure levels and get rid of excess weight, which provokes the development of thrombosis. Proper nutrition and sufficient intake of vitamins, proper sleep patterns, regular physical activity will help get rid of many diseases, incl. from blockage of blood vessels.

Pathological conditions such as occlusions are treated only by doctors; self-treatment can lead to amputation of a limb. If you notice any of the symptoms, you should immediately consult a doctor. The sooner the patient seeks help, the greater the likelihood of restoring blood flow.

Acute disturbance of peripheral circulation (Embolism, thrombosis of peripheral arteries). A sudden disruption of blood flow through the main arteries, threatening the viability of the tissues they feed, occurs as a result of thrombosis, embolism or damage.

1. Embolism.

Embolism most often leads to acute arterial occlusion. Embolism refers to the entry of a foreign body into the arterial bed, leading to its blockage. Most often, emboli are pieces of an organized blood clot, accumulations of fat or gas, or other foreign bodies (plastic tubes, metal objects, bullets).

Peripheral artery embolism occurs 2 times more often in women than in men, which is explained by women’s greater susceptibility to rheumatism and longer life expectancy. Emboli can occur at any age, but more often from 40 to 80 years.

The main sources of peripheral arterial embolism are currently considered to be heart disease (95% of all cases). Moreover, more than half of them are due to atherosclerotic cardiopathy: atrial fibrillation, myocardial infarction, post-infarction cardiosclerosis, cardiac aneurysms. Acquired heart disease accounts for 40-43% and congenital defects 1-2%. In atherosclerotic cardiopathy, the thrombus is usually localized in the left ventricle, and in case of heart defects in the left atrium or its appendage.

Following arterial embolism, acute ischemia of the limb or organ supplied by this vascular system develops. Its severity will depend on a number of factors:

1. severity of roundabout circulation,
2. continued thrombosis,
3. arterial spasm,
4. state of central hemodynamics.

A drop in intravascular pressure to a stagnation level leads to platelet aggregation and the formation of blood clots in the microcirculation system. As a result, irreversible changes in tissues occur. Later, thrombosis develops in larger arteries. Different tissues vary in their tolerance to ischemia. So in the tissues of the extremities, irreversible changes with complete ischemia occur after 6-8 hours, in the intestines after 2 hours, in the kidneys 40-50 minutes, in the brain after a few minutes.

Clinical course and symptoms of peripheral artery embolism.

The main symptom of arterial embolism is pain in the affected limb. It occurs suddenly and is very strong. Sometimes patients fall, unable to withstand this severe pain. Along with pain, patients often note a feeling of numbness in the limb.

Upon examination, a change in the color of the skin of the limb is striking: from pronounced pallor to a “marble” color. In the late stage of ischemia, when thrombosis of the venous bed occurs, the color of the skin becomes cyanotic.

With comparative palpation, the difference in skin temperature is noticeable, especially in the distal parts of the limb. There is also a disorder of all types of sensitivity (pain, tactile, deep). The border of sensitivity disorder does not coincide with the level of arterial occlusion, but is lower, which should not mislead the diagnostician.

An equally characteristic symptom is a violation of active movements in the joints of the limb, which vary in degree from limitation to complete plegia. In the late stage of severe ischemia, passive movements may also be absent due to rigidity of muscles and joints. Joint contracture is an unfavorable sign indicating the non-viability of the limb.

The absence of a pulse in the arteries located distal to the level of blockage is also one of the important symptoms of embolism. With severe swelling of the limb, it is sometimes difficult to determine the pulse. Delayed filling of the saphenous veins, or the “groove” symptom, also indicates poor circulation. Sometimes there is increased pulsation in the arteries located proximal to the occlusion, determined by comparative palpation.

In advanced cases, severe muscle soreness on palpation, rigidity and subfascial edema are observed.

Various classifications have been proposed to assess the severity of limb ischemia. The classification proposed by V.S. Savelyev and co-authors in 1978 most fully meets practical purposes.

The diagnosis of great artery embolism is usually made on the basis of physical findings. Additional research methods include ultrasound, radioisotope and X-ray contrast angiography. In this case, the main purpose of their use is to establish the patency of arteries located distal to the occlusion. It should be noted that due to spasm of both main and collateral vessels, the information content of these methods is sharply reduced.

Treatment at the prehospital stage.
Pain relief is achieved by administering drugs or analgesics. An important point is the administration of anticoagulants (10 thousand units of heparin) to prevent continued thrombosis. If necessary, cardiotonic drugs are prescribed.

The main method of treatment for embolism of the aorta and peripheral arteries should be surgical, aimed at restoring blood flow in all patients who do not have absolute contraindications to surgery. The latter include: 1. agonal state of the patient, 2. gangrene of the limb. Relative contraindications are: 1. tension ischemia or grade 1 in elderly patients (70-80 years old) with severe concomitant diseases, 2. with embolism of the end parts of the upper or lower limb, 3. with embolism of the upper limb with relative circulatory compensation and severe general condition.

Surgery.
The operation of choice is embolectomy. The best results are obtained in the early stages (6-8 hours) after the development of embolism. This is explained by the duration of tissue tolerance to ischemia, which for the limbs is within these limits. At later stages, irreversible tissue changes may develop. However, the timing itself does not determine the indications for surgery. A reliable guideline is the severity of limb ischemia, which depends on several factors: 1. level of occlusion, 2. size of the continuous thrombus, 3. state of preformed collaterals, 4. central hemodynamics. Thus, embolectomy can be successfully performed even after several days, if the limb is still viable. Tactically, emergency surgery is required (within 12 hours from the moment the patient is admitted) for grade 2-3 ischemia.

2. Acute arterial thrombosis.

Acute arterial thrombosis extremely rarely develops in healthy arteries. In more than 90% of cases, it occurs in patients with chronic obliterating diseases of the arteries of atherosclerotic (mainly) origin. More rare causes of thrombosis are: a violation of the blood coagulation system and a slowdown in blood flow. To varying degrees, they are present in patients with chronic obliterating lesions of the arteries.

Men get sick more often than women. The peak incidence occurs in the 5th-6th decade of life. The symptoms of the disease are the same as for arterial embolism and depend on the severity of ischemia and the speed of its development. In general, it is believed that the development of ischemia during thrombosis is slower and not as pronounced as during embolism. However, a differential diagnosis cannot be based on these signs. A supporting sign may be previous chronic vascular disease and the absence of embologenic sources (heart disease, aneurysm, etc.). Of the additional examination methods, it is necessary, first of all, to point out angiography, which makes it possible to establish the location and extent of the thrombosed segment, and most importantly, the condition of the arteries located distal to the thrombosis. Angiograms show characteristic signs of chronic obliterating lesions of the arteries: segmental stenoses, corroded (uneven) artery contours, formed collaterals. In embolism, on the contrary, the occlusion border has a characteristic concave surface and ends abruptly, the overlying vessels have smooth walls, and the collaterals are poorly defined.

Treatment.
In acute thrombosis, urgent surgery is indicated only in cases accompanied by severe ischemia that threatens the viability of the limb. But even in these cases, all efforts should be directed at preliminary clarification of local operability (Dopplerography, angiography).

In those patients whose limb ischemia is not severe after thrombosis, it is better to restore blood circulation in a delayed period. During this period, conservative therapy and a comprehensive examination of the patient are carried out.

Many authors put forward the following arguments in favor of delayed surgery: 1) clarification of local operability (condition of the arteries), 2) development of collateral circulation, 3) improvement of the condition of soft tissues, 4) planned surgery is always preferable to emergency surgery (trained team of surgeons, plastic material, etc. .).

Conservative treatment: 1) heparin therapy from the first hours of admission at the rate of 30,000-40,000 units. per day every 4 hours under the control of a coagulogram, 2) Reopoliglucin 400800 ml. IV drip, 3) trental 5.0 ml. x 2 times IV, 4) aspirin 100 mg. per day after 2 days, 5) nicotinic acid preparations intravenously and in tablets (nikoshpan, xanthinol nicothionate, halidor, etc.).

In some cases, fibrinolytic therapy is used. In this case, thrombus lysis is possible in the early stages by endovascular administration of thrombolytic drugs to the thrombosed segment or systemic administration of thrombolytics. Thrombolytic drugs include strepto or urokinase, fibrinolysin, etc. All of them have serious side effects, so the program for such treatment must be clearly defined, and patients must be observed in the intensive care unit.

Surgery: in case of thrombosis, it cannot be limited to thrombectomy. Reconstructive operations such as bypass surgery, thromboendarterectomy, etc. are required. In the post-operative period, conservative therapy is carried out, as indicated above.

Embolism prevention: If an embologenic focus remains, then recurrence of embolism is very likely. The main task is to identify the sources of embolism and eliminate them (for heart defects, correction of valvular insufficiency, for aortic aneurysms, subclavian artery - resection of the aneurysm).

Figure 1 – thrombosis of mesenteric vessels, intestinal ischemia

Figure 2 – removal of blood clots

Figure 3 – blood circulation restored

Fig 4 – removed thrombus