Acute arterial insufficiency is an urgent pathology requiring, most often, immediate surgical therapy. In rare cases, conservative therapy is preferred. Arterial insufficiency of veins located in the lower extremities can be triggered by a variety of reasons, but in each case it is accompanied by acute ischemic syndrome, which threatens the patient's life.
Basic concepts
Diagnosis of acute arterial insufficiency identifies the following basic terms:
- Spasm. It is a condition in which compression of the arterial lumen occurs under the influence of external or internal factors. A similar condition is characteristic of muscle arteries and mixed arteries.
- Acute thrombosis. It is a condition that is characterized by the formation of a blood clot on the background of pathological changes in the vascular walls. A blood clot is able to close the vascular lumen.
- Embolism. It is a condition characterized by occlusion of the arterial lumen with a thrombotic fragment carried by the blood stream. In this case, it is customary to call a thrombus an embolus.
Reasons for the development of OAS
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, heart rhythm disturbances play a great role in the development of embolism.
The main cause of thrombosis, in contrast to embolism, is an atherosclerotic change in the vascular walls. A spasm can develop under the influence of such external factors as hypothermia, stroke, injury. In more rare cases, cramping develops against the background of an inflammatory process affecting the tissues surrounding the artery.
Diagnosis of OAS limbs
In acute arterial insufficiency, symptoms such as:
- Lowered temperature of the affected limb.
- Lack of arterial pulsation below the lesion site. Most often, it is this symptom that is fundamental in determining the presence of OAS.
- Skin discoloration on affected limbs. It can be expressed as mild pallor, and severe cyanosis.
- Violation of sensitivity to irritants. Patients often report feeling “goosebumps” as if they had served a leg. If the situation is more severe, then the patient may not feel the limb at all.
- Pain in the limbs. This symptom, as a rule, is the first that the patient notices on his 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 for limb ischemia.
Embolism is characterized by a sudden onset and rapid clinical development of arterial insufficiency. Thrombosis with its development has less severe symptoms.
What will the survey show?
A survey of the patient in 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 symptomatology is characteristic of AN in chronic form, and may indicate atherosclerotic lesions of the arteries.
Instrumental diagnostics
Diagnosis of acute arterial insufficiency includes not only an anamnesis and physical examination, but also instrumental diagnostics. The main diagnostic method in this case is ultrasound dopplerography. With its help, it becomes possible to conduct differential diagnostics of the causes provoked by the OAS, clarify the localization of injuries, assess the nature of damage to the walls of the arteries, determine the tactics of further therapy.
Angiography
The next no less effective diagnostic method is angiography. The difference of this method lies in its invasiveness, the need to use radiopaque substances, and special preparation of the patient. This is due to the fact that dopplerography in the diagnosis of OAN is a more preferred method.
Classification of acute arterial insufficiency
After the diagnosis has been carried out, and the diagnosis is accurately established, it is required to determine the degree of ischemic damage. Currently accept to use the classification, which was developed by Savelyev V.S.
A well-defined degree of the disease allows you to correctly determine the tactics of surgical intervention for the treatment of OAS of the lower extremities. In addition, knowledge of 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:
- Stage 1 is characterized by the appearance of pain in the limbs, cooling, a feeling of paresthesia.
- Stage 2a is characterized by a disorder of active movements.
- 2b stage - active movements are completely absent.
- 2c stage - subfascial swelling of the extremities is observed.
- 3a stage - partial muscle contracture is noted.
- Stage 3b 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, 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. 2b stage allows you to postpone it only for 2 hours.
Arterial blood flow restoration
It should be borne in mind that the main method of treating acute arterial insufficiency, if embolism or acute thrombosis develops, is the restoration of arterial blood flow through surgery.
The surgeon should determine the method of anesthesia, the tactics of the intervention and its volume individually in the treatment of each patient. Surgical intervention may be open: bypass surgery, thrombectomy with a typical approach, emblectomy.
X-ray endovascular methods of therapy can also be used if the medical institution has the necessary tools.
Conservative therapy
A few words should be said about her. Conservative treatment of acute arterial insufficiency of the extremities 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 to compensate for the lack of blood flow using collaterals. The appropriateness of such therapy should be determined by the surgeon.
The restoration of blood flow becomes possible if the patient ischemia is in stages 1-2c. If a more severe form is diagnosed, the only form of surgical care is the complete amputation of a limb.
Technically, the possibility of restoration of vascular patency exists. However, decay products induced by ischemia of the extremities, falling into the systemic circulation, can provoke various complications, for example, the development of renal failure. The consequences of such complications are more dangerous than amputation of a limb. In this case, the chances of a fatal outcome increase significantly.
conclusions
Acute arterial insufficiency is not a very common pathology, in comparison with myocardial infarction or stroke.
Nevertheless, knowledge of the symptoms and nuances of treatment for such a deviation is important, both for the patient himself and for the medical professional of any profile. After all, the physical activity of each person directly depends on the health of the joints, arteries, legs in general.
If the patient has the relevant information, then he will be able to pay attention to the health of the legs at the first manifestations. In such cases, it is important not to postpone a visit to the doctor and consult with him immediately.
Timely diagnosis of acute arterial insufficiency of the lower extremities, accurate determination of the stage of the disease by Doppler ultrasonography will determine the most appropriate treatment tactics and achieve maximum results, while maintaining the patient not only health, but also physical activity in full.
Therefore, when the primary signs appear in the form of leg pain, severity, numbness, it is extremely important to immediately contact a medical institution.