Acute arterial insufficiency is an urgent pathology requiring, most often, immediate surgical therapy. In rare cases, conservative therapy is preferred. Arterial insufficiency of the veins located in the lower extremities can be triggered by a variety of reasons, but in each case it is accompanied by an acute ischemic syndrome that threatens the patient's life.
Basic concepts
Diagnosis of acute arterial insufficiency highlights the following key terms:
- Spasm. It is a condition in which the arterial lumen is compressed under the influence of external or internal factors. A similar condition is characteristic of muscular arteries and mixed arteries.type.
- Acute thrombosis. It is a condition characterized by the formation of a thrombus against the background of pathological changes in the vascular walls. The thrombus is able to close the vascular lumen.
- Embolism. It is a condition characterized by occlusion of the arterial lumen by a thrombotic fragment carried by the blood stream. In this case, it is customary to call the thrombus an embolus.
Reasons for OAN development
The etymological factor in the occurrence of embolism in most cases is the presence of cardiac pathology. It can be myocardial infarction, cardiopathy, rheumatic heart disease. Regardless of the type of cardiopathology, cardiac arrhythmias play an important role in the development of embolism.
The main cause of thrombosis, in contrast to embolism, is an atherosclerotic change in the vascular walls. Spasm can develop under the influence of such external factors as hypothermia, shock, trauma. In more rare cases, spasms develop against the background of an inflammatory process affecting the tissues surrounding the artery.
Diagnosis of OAN of the limbs
In acute arterial insufficiency, symptoms such as:
- Low temperature in affected limb.
- Absence of arterial pulsation below the lesion. Most often, this symptom is the main one in determining the presence of OAN.
- Change in skin color on affected limbs. It can be expressed as a slight pallor, and pronouncedcyanosis.
- Violation of sensitivity to stimuli. Patients often report that they feel "goosebumps", as if they had served their leg. If the situation is more severe, the patient may not feel the limb at all.
- Pain in the limbs. This symptom is usually the first that the patient notices on their own. Symptoms of acute arterial insufficiency should not be ignored.
When diagnosing and interviewing patients, it is important to focus on the timing when these symptoms arose, as well as the nature of their course. A correctly collected history allows you to establish a diagnosis and prescribe a successful treatment of limb ischemia.
Embolism is characterized by sudden onset and rapid clinical development of arterial insufficiency. Thrombosis in its development has less pronounced symptoms.
What will the poll show?
Questioning a patient during the diagnosis of pathology may show that he previously noted rapid fatigue of the legs, pain in the calf muscles, numbness of the legs. Such symptoms are characteristic of chronic AN and may indicate atherosclerotic lesions of the arteries.
Instrumental diagnostics
Diagnosis of acute arterial insufficiency includes not only history taking and physical examination, but also instrumental diagnostics. The main diagnostic method in this case is Doppler ultrasound. With its help, it becomes possible to carry out a differentialdiagnosis of the causes that provoked OAN, clarification of the localization of damage, assessment of the nature of the damage to the walls of the arteries, determination of the tactics of further therapy.
Angiography
The next equally effective diagnostic method is angiography. The difference of this method lies in its invasiveness, the need for the use of radiopaque substances, and special preparation of the patient. This is due to the fact that Dopplerography in the diagnosis of OAN is the preferred method.
Classification of acute arterial insufficiency
After the diagnosis has been made and the diagnosis has been accurately established, it is required to determine the degree of ischemic damage. At present, it is accepted to use the classification that was developed by Savelyev V. S.
A precisely defined degree of the disease allows you to correctly determine the tactics of surgical intervention for the treatment of OAN of the lower extremities. In addition, knowing the degree of blood flow disturbance allows the doctor to get an idea of whether the operation is urgent or not, whether additional preoperative preparation is necessary.
Stages of ischemia
So, acute ischemia can be of three stages:
- 1 stage is characterized by the appearance of pain in the limbs, coldness, a feeling of paresthesia.
- 2a stage is characterized by active movement disorder.
- 2b stage – there are no active movements at all.
- 2in stage – observedsubfascial swelling of the extremities.
- 3a stage - partial muscle contracture is noted.
- 3b stage is characterized by complete muscle contracture.
Often acute arterial insufficiency becomes chronic.
If the patient has ischemia in stages 1 or 2a, the doctor has the opportunity to delay surgery for about a day. At this time, an additional examination or additional preparations for the operation can be carried out. If ischemia is at a more severe stage, then surgery should be performed immediately. Stage 2b allows you to postpone it for only 2 hours.
Restoration of arterial blood flow
It should be borne in mind that the main method of treating acute arterial insufficiency, if an embolism or acute thrombosis develops, is to restore arterial blood flow through surgical intervention.
Determine the method of anesthesia, the tactics of intervention and its volume should be determined by the surgeon individually in the treatment of each patient. Surgery can be open: bypass surgery, thrombectomy with typical access, emblectomy.
X-ray endovascular methods of therapy can also be used if the medical institution has the necessary tools.
Conservative Therapy
It's worth saying a few words about her. Conservative treatment of acute arterial insufficiencylimbs is allowed if antispasmodic, antiplatelet, anticoagulant therapy was started on time, and the patient has good collateral blood flow.
In such cases, it becomes possible to dissolve the thrombus (lysis) or compensate for the missing blood flow with the help of collaterals. The appropriateness of such therapy should be determined by the surgeon.
Restoration of blood flow becomes possible if the patient has ischemia in stages 1-2c. If a more severe form is diagnosed, the only form of operative treatment is complete amputation of the limb.
Technically, the possibility of restoring vascular patency exists. However, the decay products induced by limb ischemia, entering the systemic circulation, can provoke various complications, for example, the development of kidney failure. The consequences of such complications are more dangerous than limb amputation. In this case, the chances of a fatal outcome increase significantly.
Conclusions
Acute arterial insufficiency is not too common pathology, in comparison with myocardial infarction or stroke.
However, knowledge of the symptoms and nuances of therapy for such a deviation is important, both for the patient himself and for a medical worker of any profile. After all, the physical activity of each person directly depends on the he alth of the joints, arteries, legs in general.
If the patient haswith relevant information, he will be able to pay attention to the he alth of the legs at the first manifestations. In such cases, it is important not to delay the visit to the doctor and immediately consult with him.
Timely diagnosis of acute arterial insufficiency of the lower extremities, accurate determination of the stage of the disease by Doppler ultrasound will determine the most appropriate therapy tactics and achieve maximum results, while maintaining the patient not only he alth, but also physical activity in full.
Therefore, when primary signs appear in the form of pain in the legs, heaviness, numbness, it is extremely important to immediately contact a medical facility.
