Violation of peripheral circulation: thrombosis and embolism

Violation of the central and peripheral blood 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, which includes many pathological conditions that somehow affect the blood flow.

Causes of circulatory disorders

The following situations can prevent the normal movement of blood through the vessels:

1. The lumen of the vessel is impassable. This is possible if it is blocked (for example, a thrombus or an atherosclerotic plaque) or constriction (stenosis).
2. Pathological changes in the wall (hypertrophy in hypertension).
3. Pressurization of the vessel from the outside (eg, a tumor).
4. Damage of the vascular wall.
5. Change in rheological properties of blood.
6. Reduction of the volume of circulating blood (with bleeding, dehydration).
7. Reduction of blood pressure (shock, heart failure).
8. The pathology of the heart (vices, heart failure), at which the volume of blood ejected into the systole decreases.

All these situations can affect the blood flow of both the main and peripheral vessels. In the case of heart problems, hemodynamic disorders, changes in the volume of circulating blood, pathology of coagulation mechanisms, blood circulation will be disrupted at all levels - from large vessels to the smallest ones. Local violations (stenosis, thrombosis, hypertrophy of the vascular walls) are reflected directly in the area where they originated.

The causes of peripheral circulatory disorders, in principle, are the same as the central one. However, speaking about the pathology of blood flow at the periphery, first of all, local blood circulation disorders are implied.

Violation of peripheral circulation in surgery is primarily a situation associated with local cessation of blood flow: thrombosis, embolism, clamping of the vessel, atherosclerosis. All these conditions (with the exception, perhaps, of atherosclerosis) are urgent, requiring immediate assistance.

Violation of peripheral circulation: symptoms

What is the local cessation of blood flow? Tissues that are without adequate blood supply begin to experience ischemia, because now they do not get the oxygen necessary for normal life. The stronger the lack of nutrition, the faster the death of cells. In the absence of necessary care gangrene develops (ie, necrosis of the bloodless tissues).

Violation 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, obliterating thromboangiitis. Blood flow in the vessels is disturbed due to the narrowing of their lumen due to the gradual growth of atherosclerotic plaque or thickening of the walls as a result of a nonspecific inflammatory reaction.

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

1. Compensation stage. It is characterized by the appearance of weakness in the legs, seizures and discomfort on the background of physical exertion. However, the pain appears only when walking at a distance of at least 0.5-1 km.
2. Stage of subcompensation. Stop the walk because of pain in the legs, the patient is forced to already through 0.2-0.25 km. Lower extremities undergo some changes due to lack of blood supply: pale, dry, flaky skin, brittle nails, thinned subcutaneous fat layer. Pulsation on the arteries is weakened.
3. The stage of decompensation. Walking without pain is possible at a distance of not more than 100 m. Muscular hypotrophy is observed, the skin becomes lightly injured, cracks and ulcers appear on its surface in a multitude.
4. Stage of destructive changes. In this situation, the blood flow in the vessels almost completely stops. Lower limbs are covered with ulcers, in particularly severe cases, gangrene of the fingers develops. Labor capacity is sharply reduced.

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

Arterial thrombosis and embolism

In this case, there are acute violations of peripheral arterial blood circulation, which in a few hours can lead to the development of gangrene of the limb, if timely assistance is not provided.

A thrombus in the artery can form on an atherosclerotic plaque, in the area of inflammation of the vessel wall or its damage. An embolus is a thrombus, brought by a blood stream from another part of the vascular bed. As a result, the lumen of the vessel completely overlaps, the blood flow stops, the tissues begin to experience ischemia, and if this situation continues for a long time, they die (gangrene develops).

Clinic of acute peripheral circulation disorders

The most rapid change in symptoms occurs with embolism, because in this case, the cessation of blood flow occurs suddenly, leaving no opportunity for compensatory changes.

For the first two hours, the patient experiences severe pain in the limb. The latter becomes pale and cold to the touch. Pulsation on the distal arteries is absent. Gradually, the pain decreases, and with it the sensitivity is reduced, even until 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 rapid. The growth of the thrombus requires a certain time, therefore, the blood flow is not violated immediately. In accordance with the classification of Saveliev, 3 degrees of ischemia are distinguished:

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

Violation of peripheral circulation: treatment

Tactics depends on the severity of ischemia and the rate of development of irreversible changes in tissues. Acute violations of peripheral circulation require surgical treatment. In the case of gradual deterioration of blood flow in the stages of compensation for a good result, conservative therapy can be achieved.

Operations for acute blood flow disorders

Conservative treatment in this case is inefficient, because it is not able to completely destroy the thrombus and remove the obstruction to the blood flow. Its appointment 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 the blood flow as follows. In the lumen of the affected artery, the Fogarty catheter is inserted above the occlusion site, with the help of which the thrombus is removed. For the insertion of the catheter, surgical access is performed at the level of the femoral artery bifurcation (with the lesion of the lower limb) or the brachial artery (when the upper limb is affected). After performing an arteriotomy, the Fogarty catheter is advanced to the site of the occlusion of the vessel by a thrombus, passed through the obstruction, then inflated and in this condition is removed. An inflated balloon at the end of the catheter captures and entrains a thrombus.

In the case of thrombosis in the area of the organically altered vessel wall, the likelihood of recurrence is high. Therefore, after the restoration of blood flow, it is necessary to perform a planned reconstructive operation.

If the situation was started and the 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. Basic principles of therapy:

1. Elimination of factors that provoke spasm of the arteries: smoking, alcohol, hypothermia.
2. Purpose of antispasmodics.
3. Analgesics for relief of pain syndrome.
4. Reducing the viscosity of blood by prescribing antiplatelet agents and anticoagulants.
5. A diet aimed at lowering cholesterol in the blood.
6. Statins for the normalization of lipid metabolism.
7. Treatment of concomitant diseases, detrimental to the vessels: hypertension, diabetes, atherosclerosis.

However, the most effective method of treatment remains reconstructive surgery - shunting (creation of bypass anastomosis), stenting (stent installation in the lumen of the vessel).

Let's sum up the results

Violation of the peripheral circulation may be due to various reasons. It is important to remember that long-existing or acute blood flow disorders can lead to irreversible changes in tissues and result in gangrene.

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