Peripheral Circulatory Disorder: Thrombosis and Embolism

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, including many pathological conditions that somehow affect the blood flow.

Causes of circulatory disorders

Different situations can interfere with the normal movement of blood through the vessels:

1. The lumen of the vessel is impassable. This is possible in case of blockage (for example, a blood clot or atherosclerotic plaque) or narrowing (stenosis).
2. Pathological changes in the wall (hypertrophy with arterial hypertension).
3. Compression of the vessel from the outside (for example, a tumor).
4. Damage to the vascular wall.
5. Change in the rheological properties of blood.
6. Reducing the volume of circulating blood (with bleeding, dehydration).
7. Decreased blood pressure (shock, heart failure).
8. Heart pathology (defects, heart failure), in which the volume of blood released into the 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 disturbances, changes in the volume of circulating blood, pathology of coagulation mechanisms, blood circulation will be impaired at all levels - from large vessels to the smallest. Local disorders (stenosis, thrombosis, hypertrophy of the vascular walls) are directly reflected in the area where they arose.

The causes of peripheral circulation disorders are, in principle, the same as the central ones. However, speaking about the pathology of blood flow at the periphery, local blood circulation disorders are primarily meant.

Disturbance of peripheral blood circulation in surgery is, first of all, situations associated with local cessation of blood flow: thrombosis, embolism, constriction of the vessel, atherosclerosis. All these conditions (with the possible exception of atherosclerosis) are urgent and require immediate assistance.

Peripheral Circulatory Disorder: Symptoms

What is the manifestation of a local cessation of blood flow? Tissues that find themselves without adequate blood supply begin to experience ischemia, because now they do not receive the oxygen necessary for normal functioning. The greater the lack of nutrition, the faster the death of cells. In the absence of the necessary help, gangrene develops (i.e., the death of tissues deprived of blood supply).

Disturbance of the 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 the narrowing of their lumen due to the gradual growth of an atherosclerotic plaque or thickening of the walls as a result of a nonspecific inflammatory reaction.

Disturbance of peripheral circulation in this case is manifested by the following clinical picture:

1. Stage of compensation. It is characterized by the appearance of weakness in the legs, cramps and discomfort due to physical exertion. However, pain appears only when walking at a distance of at least 0.5-1 km.
2. 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 a lack of blood supply: pale, dry, flaky skin, brittle nails, a thinned subcutaneous fat layer. Ripple on the arteries is weakened.
3. Stage of decompensation. Walking without pain is possible at a distance of not more than 100 m. Muscle hypotrophy is observed, the skin becomes easily injured, cracks and sores appear on its surface in many.
4. Stage of destructive changes. In this situation, blood flow in the vessels almost completely stops. The lower limbs are covered with ulcers, in especially severe cases, gangrene of the fingers develops. Disability is sharply reduced.

Of course, a violation of peripheral circulation with this pathology develops for a long time. A lot of time passes before the gangrene stage, during which you can take the necessary measures to prevent the complete cessation of blood flow.

Arterial thrombosis and embolism

In this case, acute disturbances of peripheral arterial circulation occur, which in a few 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 blood clot brought by a blood stream 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 when this situation persists, they die (gangrene develops).

Clinic of acute peripheral circulatory disorders

The most rapid change in symptoms is observed with embolism, because in this case, the cessation of blood flow occurs suddenly, leaving no opportunity 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 ripple in the distal arteries. Gradually, the pain decreases, and with it the sensitivity is muffled up to complete anesthesia. The motor functions of the limb also suffer, eventually paralysis develops. Very soon, irreversible changes in tissues and their death occur.

With 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, blood flow is not immediately disturbed. In accordance with Savelyev’s classification, 3 degrees of ischemia are distinguished:

1. It is characterized by disorders of sensitivity.
2. Movement disorders join.
3. At this stage, tissue necrosis begins.

Peripheral Circulatory Disorder: Treatment

Tactics depend on the severity of ischemia and the rate of development of irreversible changes in the tissues. Acute peripheral circulation disorder requires surgical treatment. In the case of a gradual deterioration in 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 a blood clot and remove an obstruction to blood flow. Its purpose is possible only in the case of severe concomitant pathology, provided that the 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 blockage, with which the thrombus is removed. For catheter insertion, surgical access is carried out at the level of the bifurcation of the femoral artery (with lesions of the lower limb) or the brachial artery (with lesions of the upper limb). After arteriotomy, the Fogarty catheter is advanced to the site of clogging of the vessel with a blood clot, passed through an obstacle, after which it is inflated and removed in this state. An inflated balloon at the end of the catheter captures and carries with it a blood clot.

In case of thrombosis in the area of ​​the organically altered vessel wall, the probability of relapse is high. Therefore, after the restoration of blood flow, a planned reconstructive operation is necessary.

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. The basic principles of therapy:

1. Elimination of factors that provoke spasm of the arteries: smoking, alcohol, hypothermia.
2. The appointment of antispasmodics.
3. Analgesics for the relief of pain.
4. Decrease in blood viscosity by the appointment of antiplatelet agents and anticoagulants.
5. A diet aimed at lowering blood cholesterol.
6. Statins to normalize lipid metabolism.
7. Treatment of concomitant diseases that adversely affect blood vessels: hypertension, diabetes mellitus, atherosclerosis.

However, the most effective treatment method is reconstructive surgery - bypass surgery (creating a bypass anastomosis), stenting (installing a stent in the lumen of the vessel).

To summarize

Disturbance of 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 the tissues and result in gangrene.

For the prevention of vascular disorders, it is necessary to maintain a healthy lifestyle, proper nutrition, rejection of bad habits, as well as timely treatment of diseases that contribute to the development of angiopathies.