Diagnosis and treatment of acute arterial embolism
What is arterial embolism?
Artery embolism refers to a blood clot or into the intravascular foreign bodies become embolus, with the blood pause in diameter similar smaller peripheral arteries or visceral artery artery in, causing blood disorder. The main artery embolism caused by thromboembolism, moreover, tumor, air, fat and other foreign bodies may also become. The most common thrombosis. 90% of the thrombus originates from the heart, which is commonly seen in rheumatic heart disease, atrial fibrillation and myocardial infarction. Embolism caused by thrombosis occurs frequently in patients with cardiovascular disease. The source of embolism has the following aspects:
Many reports indicate that the most common cause of peripheral arterial embolization is cardiac. Embolism from heart disease accounted for 94%, of which 77% patients with atrial fibrillation. Atherosclerosis of coronary heart disease, including myocardial infarction, atrial fibrillation, congestion heart failure and ventricular arterial wall tumor accounted for about 60%, rheumatic heart disease accounted for 20%. Rheumatic heart disease and coronary heart disease, the two have left heart thrombosis. In rheumatic heart disease, especially mitral stenosis, atrial stagnant blood flow and to the intima of the air temperature changes, blood fiber attached to the atrial wall thrombosis. Coronary heart disease, especially when myocardial infarction, left ventricular expansion, contraction fatigue, blood can not be emptied, more prone to thrombosis.
Two arterial atherosclerosis and arterial atherosclerosis in the form of embolism, recently reported increased. Large embolization can be derived from a mixture of large artery atherosclerosis, thrombosis, and a mixture of alcohol and alcohol, shedding blood into the arteries. Small embolism due to the release of bile due to alcohol or due to the release of the ulcer caused by arteriosclerosis spots off.
Three iatrogenic in recent years, due to the extensive development of artificial heart valve replacement and artificial blood vessel transplantation, the placement of pacemakers and arterial angiography, blood dialysis dynamic arterio venous shunt, indwelling catheter and artery counterpulsation application of balloon catheter, may cause arterial embolism
Acute arterial embolism can lead to limb remote ischemic necrosis, if not timely lifting of embolism, severe cases will lead to amputation, even because of limb necrosis after toxin absorption caused by patients with systemic organ failure leading to death.
Two, clinical manifestations
Patients with acute arterial embolism and without collateral circulation, the disease is progressing rapidly. Manifested as pain, pale, cold limbs, numbness, movement disorders, and arterial pulse fade and disappear is the typical symptoms of acute arterial embolism. The severity of the symptoms depends on the location, degree, and the number of secondary thrombosis, whether previously had atherosclerotic disease caused by arterial stenosis, as well as collateral circulation.
The pain, the pain is often the first symptoms, to gradually extended to the distant buckle. About 20% of the patients first appeared symptoms of numbness, and pain is not obvious.
Skin color and temperature change, blood circulation disorder of limbs, skin is pale waxy. If the vessel is in the accumulation of a small amount of blood, pale skin can occur between scattered in the island like purple. The further development of ischemia, muscle stiffness, lower limb skin temperature decreased, the skin appears piebald change even with ukraine. The distal part of the limb is the most obvious. Temperature change actually embolism to a lower joint plane. End of abdominal aorta embolism, skin temperature change about in bilateral thighs and buttocks, common iliac artery about lower thigh, femoral artery about in the central part of the thigh, popliteal artery about in the lower part of the leg.
Arterial pulsation weakened or disappeared: first palpation with the dorsalis pedis artery and the posterior tibial artery, such as touch to beat, then palpate popliteal artery, and finally the femoral artery. A preliminary confirmation of the position of the embolism.
Numbness and movement disorders: the distal limb of a stocking type infection loss area, which is due to peripheral nerve dysfunction caused by ischemia. Near the end there is a sense of decline, and then the proximal end can have a sense of allergy, the affected limb can also have a needle like feeling, muscle weakness, or even paralysis, there is not the degree of hand and foot drop.
Three, diagnosis
(a) a history of cardiovascular disease.
(two) there are 5 "P" signs
1 pain (Pan): severe pain due to tissue ischemia and hypoxia.
2 (Pallor): pale and cold clammy skin.
3 (Paresthesia): numbness of the distal limb of a stocking type feel more lost area.
4 movement disorders (Paraalysis): muscle weakness, or even paralysis.
5 arterial pulse weakening or disappearance (Pulselessness).
(three) vascular color Doppler ultrasound examination: there was no pulsation and blood flow in the distal artery of the embolism site.
(four) arterial CT (CTA) in order to determine the location, extent and degree of embolization.
Four, treatment
1 surgical treatment: acute arterial embolism, surgery is the first choice. Once the cause of the disease, emergency action to open the portal vein surgery can be effective in the shortest period of time to remove the embolism, restore blood supply, to maintain the maximum degree of limb. General emergency take effect in 24 hours after embolization
2 non surgical treatment: if there is no local conditions, or for the diagnosis of embolism is not clear. Anticoagulant and thrombolytic therapy. General use of intravenous infusion of urokinase 20WU, two times a day + low molecular weight heparin calcium 4100U subcutaneous injection, two times a day. Thrombolytic therapy in general on the occurrence of 3 days or less in the fresh thrombus effect, and more than 7 days, the effect is poor; the use of regional arterial catheter infusion than systemic drug effect is good.
MOBILE Version
