Violation of the central and peripheral circulation develops for various reasons. However, the clinical picture of this condition is recognizable and typical in all cases. In surgical practice, this is a fairly common problem, which includes many pathological conditions that affect blood flow in one way or another.
Causes of poor circulation
Different situations can prevent the normal movement of blood through the vessels:
- The lumen of the vessel is impassable. This is possible if it is blocked (for example, by a thrombus or atherosclerotic plaque) or narrowed (stenosis).
- Pathological changes in the wall (hypertrophy in arterial hypertension).
- Squeezing the vessel from the outside (for example, by a tumor).
- Injury to the vascular wall.
- Change in the rheological properties of blood.
- Decrease in circulating blood volume (due to bleeding, dehydration).
- Lower blood pressure (shock,heart failure).
- Pathology of the heart (defects, heart failure), in which the volume of blood ejected into systole decreases.
All these situations can affect the blood flow of both the main and peripheral vessels. In the event of problems with the heart, hemodynamic disorders, changes in the volume of circulating blood, pathology of coagulation mechanisms, blood circulation will be disturbed at all levels - from large vessels to the smallest. Local disturbances (stenosis, thrombosis, hypertrophy of the vascular walls) are reflected directly in the area where they have arisen.
The causes of peripheral circulatory disorders are, in principle, the same as the central ones. However, speaking about the pathology of blood flow in the periphery, first of all, they mean local disorders of blood circulation.
Peripheral circulatory disorders in surgery are primarily situations associated with local cessation of blood flow: thrombosis, embolism, vessel clamping, atherosclerosis. All of these conditions (with the possible exception of atherosclerosis) are emergencies that require immediate attention.
Peripheral circulatory disorders: symptoms
What is the manifestation of local cessation of blood flow? Tissues that are without adequate blood supply begin to experience ischemia, because now they do not receive the oxygen necessary for normal life. The stronger the lack of nutrition, the faster cell death occurs. In the absence of the necessary assistancegangrene develops (i.e., necrosis of tissues deprived of blood supply).
Impaired peripheral circulation of the lower extremities is the most striking example. Blood flow disorders in this case can develop suddenly or gradually.
Intermittent claudication
The most common causes of this condition are atherosclerosis of the arteries of the lower extremities, nonspecific aortoarteritis, thromboangiitis obliterans. The blood flow in the vessels is disturbed due to narrowing of their lumen due to the gradual growth of atherosclerotic plaque or thickening of the walls as a result of a non-specific inflammatory reaction.
Violation of peripheral circulation in this case is manifested by the following clinical picture:
- Compensation stage. It is characterized by the appearance of weakness in the legs, cramps and discomfort against the background of physical exertion. However, the pain appears only when walking at a distance of at least 0.5-1 km.
- The stage of subcompensation. The patient is forced to stop walking due to pain in the legs after 0.2-0.25 km. The lower extremities undergo some changes due to lack of blood supply: pale, dry, flaky skin, brittle nails, thinned subcutaneous fat layer. The pulsation in the arteries is weakened.
- Stage of decompensation. Walking without pain is possible at a distance of no more than 100 m. Muscle hypotrophy is observed, the skin becomes easily injured, cracks and sores appear in many cracks and sores on its surface.
- Destructive stagechanges. In this situation, the blood flow in the vessels almost completely stops. The lower extremities are covered with ulcers, in especially severe cases, gangrene of the fingers develops. Employability is sharply reduced.
Of course, violation of peripheral circulation in this pathology develops for a long time. It takes a long time before the stage of gangrene, during which you can take the necessary measures to prevent the complete cessation of blood flow.
Arterial thrombosis and embolism
In this case, there are acute violations of the peripheral arterial circulation, which in a matter of hours can lead to the development of gangrene of the limb, if timely assistance is not provided.
A thrombus in an artery can form on an atherosclerotic plaque, in the area of inflammation of the vessel wall or its damage. An embolus is a thrombus brought by blood flow from another part of the vascular bed. As a result, the lumen of the vessel is completely blocked, the blood flow stops, the tissues begin to experience ischemia, and if this situation persists for a long time, they die (gangrene develops).
Acute Circulatory Disorder Clinic
The most rapid change in symptoms is observed with embolism, because in this case, the cessation of blood flow occurs suddenly, leaving no room for compensatory changes.
The first two hours the patient experiences severe pain in the limb. The latter becomes pale and cold to the touch. There is no pulsation in the distal arteries. Gradually, the pain decreases, and along with it, the sensitivity is muffled up to complete anesthesia. The motor functions of the limb also suffer, eventually paralysis develops. Very soon there are irreversible changes in the tissues and their death.
In thrombosis, the picture is basically the same, but the development of the clinic is not so fast. The growth of a blood clot requires a certain time, therefore, the blood flow is not immediately disturbed. In accordance with Saveliev's classification, there are 3 degrees of ischemia:
- Characterized by sensory disturbances.
- Motor disorders join.
- At this stage tissue necrosis begins.
Peripheral circulatory disorders: treatment
The tactics depend on the severity of ischemia and the rate of development of irreversible changes in tissues. Acute peripheral circulatory disorders require surgical treatment. In case of a gradual deterioration of blood flow at the stages of compensation, a good result can be achieved with conservative therapy.
Surgery for acute blood flow disorders
Conservative treatment in this case is ineffective, because it is not able to completely destroy the clot and eliminate the obstruction to blood flow. Its appointment is possible only in case of severe concomitant pathology, provided that compensatory reactions are sufficient. After stabilization of the patient's condition, an operation is performed to remove the thrombus from the lumen of the vessel.
Restore blood flow as follows. A Fogarty catheter is inserted into the lumen of the affected artery above the site of blockage, with the help of which the thrombus is removed. For the introduction of the catheter, surgical access is carried out at the level of the bifurcation of the femoral artery (in case of damage to the lower limb) or the brachial artery (in case of damage to the upper limb). After performing an arteriotomy, the Fogarty catheter is advanced to the site of blockage of the vessel by a thrombus, passed through the obstruction, and then inflated and removed in this state. The inflated balloon at the end of the catheter traps and carries the clot with it.
In the event of thrombosis in the area of an organically altered vessel wall, there is a high probability of recurrence. Therefore, after the restoration of blood flow, it is necessary to perform a planned reconstructive operation.
If the situation was started and gangrene of the limb developed, amputation is performed.
Therapy for obliterating diseases of the arteries
Conservative treatment is prescribed in the early stages of the disease, as well as in the presence of contraindications to surgical methods of treatment. Basic principles of therapy:
- Elimination of factors that provoke arterial spasm: smoking, alcohol, hypothermia.
- Prescribing antispasmodics.
- Analgesics for pain relief.
- Reduce blood viscosity by prescribing antiplatelet agents and anticoagulants.
- Cholesterol-lowering diet.
- Statins for lipid normalizationexchange.
- Treatment of concomitant diseases that adversely affect blood vessels: hypertension, diabetes, atherosclerosis.
However, reconstructive surgery remains the most effective method of treatment - bypass surgery (creation of a bypass anastomosis), stenting (insertion of a stent into the vessel lumen).
Summarize
Impaired peripheral circulation can be due to various reasons. It is important to remember that long-term or acute blood flow disorders can lead to irreversible changes in tissues and result in gangrene.
To prevent vascular disorders, it is necessary to maintain a he althy lifestyle, proper nutrition, giving up bad habits, as well as timely treatment of diseases that contribute to the development of angiopathy.
