From chronic to acute peripheral ischemia
What is peripheral vascular ischemia
The term ischemia refers to the interruption of arterial blood flow in this case at the level of the lower and upper limbs. Depending on the duration of time of the ischemic process, smaller or larger, it is classified into acute ischemia - a serious emergency that requires rapid intervention and chronic. In the case of chronic one, the pathological process evolves slowly, for a longer time so that the body develops compensatory mechanisms.
Which are the determinants of peripheral vascular ischemia
Both types of peripheral vascular ischemia are caused by arterial obstruction of upper / lower limb blood flow through:
- thrombi that may be atheromatous (fatty in origin);
- macroemboli of cardiac or endovascular origin;
- microembolisms that have as a starting point the arterial aneurysms (dilatations of the arterial walls that favors the alteration of the blood flow with the formation of clots);
- rarely tumour fragments.
Other possible causes of peripheral ischemic syndromes are arterial trauma (circulation accidents, firearms) or external compression syndromes (given by bulky tumour masses or massive compartment-oedema syndromes of soft tissues in inextensible spaces).
How the disease manifests itself
Acute ischemia is manifested by acute pain in the affected limb accompanied by functional impotence, pallor and numbness or loss of skin sensitivity and decreased skin temperature.
Chronic deprivation of oxygen tissues is more common in the lower limbs and causes "intermittent claudication" represented by fatigue, discomfort or pain in the leg induced by movement or physical exertion (cycling, walking long distances). The specific elements of chronic ischemia are muscle stiffness, paralysis, skin lesions and signs of venous thrombosis.
Self-assessment of peripheral ischemia
Acute ischemia is easily recognizable due to the "noisy" symptoms that appear suddenly, any acute pain accompanied by functional impotence of the lower arm or limb should send us urgently to a specialist. Untreated acute ischemia can have serious, irreversible consequences 4-6 hours after onset, including loss of the affected limb!
When chronic vascular ischemia sets in, the pain appears gradually, initially during exertion (lifting weights with the help of arms, walking) and then as the disease progresses there is discomfort at rest and/or at night. The evolution of the disease is monitored by following the gait perimeter in case of intermittent claudication (the pain appears at shorter and shorter distances and forces us to stop frequently) and in case of arterial ischemia of the upper limb it is useful to monitor the pulse (it is determined localization of the arterial block between the first and last point at which the pulse is perceived).
Treatment
The administered medication has the role of restoring circulation with the prevention of peripheral arterial re-occlusion and of limiting the extent of thrombosis, being represented by injectable anticoagulants (subcutaneous or intravenous). Systemic thrombolytics have the role of "dissolving" the clot by re-permeabilizing the obstructed artery.
Walking
After identifying the location of the arterial block and checking the condition of the arteries, the surgical treatment aims to remove the thrombus (indirect embolism with Fogarty tube or thrombendarterectomy - remove the thrombus with the artery blocked) followed by repair or replacement of the affected vessel (venous bypass graft) resumption of blood flow in that territory.
Minimally invasive surgery uses chemical thrombolytic agents that are inserted into the artery using a catheter, the method having the advantage of allowing the thrombotic material to be aspirated or a stent to be inserted to prevent arterial re-occlusion,all in the same therapeutic session.