Acute occlusion of the vessels of the extremities

Acute occlusion of the vessels of the extremities is caused by embolism or thrombosis of the vessels. The clinical picture is characterized by sudden pain in the limb (75-80%). Pain may be absent in those cases when from the very beginning full anesthesia develops quickly, pain may be minimal if the collateral circulation is preserved. Pale skin in the initial stage is replaced by cyanosis with a marble pattern and a sharp decrease in skin temperature. This is an important sign that determines the degree of reduction of blood supply to the limb. Paralysis and paresthesia (or anesthesia) are important in determining the severity of ischemia, since the endings of the peripheral nerves are very sensitive to anoxia. In the presence of paralysis and paresthesia, as a rule, there is gangrene and, conversely, with the preservation of motor and sensitive limb function, despite the presence of signs of ischemia, gangrene is usually not found. Absence of pulse confirms the diagnosis and allows to determine the place of occlusion. When the limb is swollen, the lack of a pulse can be determined using ultrasound dopplerography.

The diagnosis is based on anamnesis and the identification of cardiac pathology. There are 3 degrees of ischemia of the affected limb (VS Saveliev): with ischemia ia degree there is a feeling of numbness, cold snap, paresthesia; With ischemia grade 16 - pain. With grade II ischemia, there are impaired sensitivities and active movements in the joints of the limbs (from the paresis cuticle and the degree to paralysis with grade IIb). Ischemia of the third degree is characterized by beginning necrobiotic phenomena - subfascial edema at grade III a and muscular contracture at III b, degree. The end result of ischemia is gangrene of the extremity. The greatest information about the nature and extent of the pathological process, the state of collateral blood flow is provided by angiography.

Treatment. Anti-shock measures, low limb position, plasmapheresis with the introduction of large quantities of freshly frozen plasma (see Compression Syndrome), in later terms - heparin to reduce the intensity of thrombus formation. Surgical intervention is advisable to be carried out within the first 6 hours from the onset of the disease: an arteriotomy is performed and the embolus is removed with a Fogarty probe; With arterial thrombosis produce thrombinectomy. After the operation, heparin therapy and treatment of cardiac pathology are shown to reduce recurrence of embolism and rethrombosis. At the III stage of ischemia, vascular surgery is contraindicated due to the danger of turnstile syndrome (similar to the syndrome of prolonged crushing). In embolism of arterial vessels distal to the knee or elbow joint, a conservative