Occlusion of the main arteries

Occlusion of the main arteries leads to acute or chronic impairment of the blood supply to the anatomical region or organ. Acute disorders of blood supply are caused by embolism or thrombosis of the vessel. In 95% of the causes of embolism is the pathology of the heart: defects of the mitral or aortic valve, atrial fibrillation, condition after myocardial infarction with the formation of parietal thrombi, aneurysm of the heart, septic endocarditis. In 5% of cases, the source of embolism is the formation of thrombotic masses in arterial aneurysms, especially in thoracic and abdominal aortic aneurysms, after surgical interventions on the vascular system, in trauma, venous thrombosis with an uninfected oval opening with increased right atrial pressure (paradoxical embolism) . Embolism often occurs in places of physiological or secondary arterial arteries, mainly in the bifurcation of large vessels. This leads to the simultaneous shutdown of at least two large areas of blood flow, which is accompanied by blockade of collateral circulation. In 45% of cases, embolus blocks the femoral artery, in 15% iliac and popliteal, in 8% - bifurcation of the aorta, rarely - vessels of the hands, shin, brain, mesenteric vessels.

In acute embolism, the time of ischemia 4-6 h is critical, with a longer period of the disease, it is usually impossible to fully restore the function of the limb. With an increase in the timing of embolism in the distal arteries, there is a thrombosis that significantly complicates the surgical intervention and worsens the prognosis of the disease. At the final stage, there is thrombosis and venous system, surgical treatment of this stage is ineffective.

The second cause of acute occlusion of arterial vessels is thrombosis, which occurs in the area of ​​the altered arterial wall (atheromatosis, endarteritis). Less often thrombosis occurs as a result of compression of the artery from the outside with fractures, dislocations, hematomas, thrombocytopathy of various genesis. Very rarely, the cause of violation of the arterial blood circulation can be a sharp spasm of the artery after the introduction of contrast agents, poisoning with nicotine and ergotamine. The diagnosis is complicated when the fracture is combined with compression of the arterial vessel and secondary thrombosis.

Since acute thrombosis often occurs on the basis of atherosclerotic vessel damage, in which there is already a developed network of collaterals, the clinical picture of the disease is not as acute as in embolism, and the time of reversible limb ischemia is greater.