Acute limb ischemia

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Acute limb ischemia develops as a result of sudden interruption of blood flow through the arteries caused by embolism or arterial thrombosis. Most often it affects the lower limbs. The ailment is characterized by severe pain, disturbed sensation in the limb, and it turns pale and cold.

Acute limb ischemia – description of the disease

Acute limb ischemia is a situation in which the flow of arterial blood to the limb is completely interrupted or reduced. This could be due to a blockage or thrombosis in the artery. The amount of blood is so insufficient that it is impossible to properly maintain the resting metabolism in the area of ​​vascularization. The rapid worsening of the condition in the short term may lead to limb necrosis and, in extreme cases, the patient’s death. However, in today’s medicine there are techniques that allow for relatively quick diagnosis of the disease and thus give a chance to implement the appropriate treatment. Mortality due to acute limb ischemia is estimated at about 15%.

Causes of acute limb ischemia

Most cases of acute limb ischemia occur as a result of embolism (almost 50% of cases) or arterial thrombosis (35% of cases). Less common causes are:

1. vessel injuries,
2. contusion of a limb,
3. aortic dissecting aneurysm,
4. frostbite,
5. chemical poisoning,
6. cyanotic painful swelling of the limb,
7. complete disruption of the venous circulation.

An embolus is an obstruction of an artery by an embolic material, most often a thrombus. The source of its creation is a sick heart. The cause of a blood clot in the heart is irregularity, atrial fibrillation or a heart attack.

Acute thrombosis arising from atherosclerosis can also cause acute ischemia due to occlusion of the lumen of the artery by a thrombus formed on the atherosclerotic plaque.

Symptoms of acute limb ischemia

The symptoms occurring in the course of the disease are a consequence of acute ischemia of the relevant muscle groups supplied by the closed artery. The early stage disease is characterized by:

1. pain and pale and cooling of the limb,
2. sensory and movement disorders,
3. muscle weakness
4. the formation of blue-red spots, mainly in the peripheral parts of the limb,
5. collapse of superficial veins,
6. lack of pulse peripherally to the 2nd blood flow interruption,
7. a change in the color of the skin (first white and then chalky).

With the development of the disease, edema and necrotic changes appear in the striated muscles. In addition, there is a concentration and contracture of the 2nd muscles.

Acute limb ischemia and arterial embolism

An embolus is a partial or complete blockage of the lumen of an artery, most often by a thrombus. The site of embolism is most often vessel bifurcation, e.g. when it is located in several vessels, it is called arterial embolism. The embolic material in most cases is the aforementioned blood clots that form in the heart as a result of heart rhythm disturbances or infarction. Other causes of an embolism may include:

1. pulmonary vein thrombosis resulting from trauma;
2. blood clots due to inflammation;
3. blood clots that form in the vicinity of the tumor;
4. blood clots that occur with other ailments of the chest organs.

In some patients, embolic material may also be, for example, fragments or balls, which are foreign bodies penetrating the left ventricle of the heart. Also, operations on the heart or abdominal organs can lead to the formation of blood clots in the lumen of the vessel.

Symptoms of blockage

Embolism is very often preceded by atrial fibrillation, which may be accompanied by periodic activation of accumulating thrombi. The emboli are usually located in the bifurcation of the arteries and the initial section of the arterial entry into the muscle canals. In the area of ​​the embolus (in the proximal part), thrombus formation is often additionally formed. However, in the distal segment – prolonged thrombuses. Embolism is accompanied by pain and a decrease in skin temperature. Additionally, precipitation spots and blood blisters form. Patients may experience muscle weakness and even their paresis. As a consequence, peripheral necrosis may occur.

Treatment of congestion

It mainly involves surgical treatment, the essence of which is to restore blood flow. To this end, the embolic material is removed from the lumen of the vessel. The surgical procedure in the form of embolectomy is minimally invasive and uncomplicated. It is usually performed under general anesthesia. The doctor enters the vessel lumen through the common femoral artery (in the case of the lower limb) or through the brachial artery before its division (in the case of the upper limb). In some patients, such as those who are overweight or who have had a stroke, a different type of anesthetic may be considered. It can be spinal, epidural or general endotracheal anesthesia. The general condition of the patient influences the choice of the type of surgery.

Properly performed surgery allows to remove the blockage and prevents the occurrence of functional defects. The later the procedure is performed and the longer the period of ischemia, the smaller the chance of saving the limb.

Embolism and arterial thrombosis

Arterial thrombosis occurs as a result of various vascular diseases, such as hypercoagulability or impaired blood flow. Thrombosis usually occurs in those sections of the vessels that are severely constricted by the developing atherosclerotic lesions. Arterial thrombosis shortly after embolism is considered to be the most common cause of ONK (acute limb ischemia).

Other possible causes of thrombosis:

1. Buergera’s disease
2. popliteal aneurysm,
3. vessel injuries,
4. previous reconstructive procedures, e.g. restoration of arteries,
5. dehydration of the body (diarrhea); especially in elderly people,
6. smoking,
7. drinking a lot of alcohol
8. diabetes,
9. prolonged immobilization of the limb,
10. congenital / acquired coagulation disorders, e.g. thrombophilia.

symptoms

The development of thrombosis leads to:

1. limb pain,
2. cool the limb,
3. lack of heart rate,
4. sensory disturbances,
5. local cyanosis,
6. pale skin,
7. formation in places affected by thrombosis: blisters or ecchymosis.

Diagnosis and treatment

The diagnosis of thrombosis is made on the basis of a medical interview with the patient, imaging tests in the form of Doppler ultrasound and arteriography (showing atherosclerotic changes). Treatment is conservative and aims to mitigate the effects of thrombosis. Thanks to vasoactive preparations, the aim is to move the clot as far peripherally as possible. Taking heparin prevents the development of both the clot above and below the embolism. In treatment, it is important to minimize pain and, above all, to treat the underlying disease that led to thrombosis.

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Surgical treatment is based on opening an artery and then removing the clot formed (embolectomy). Bypasses are also performed. In extreme cases, where the patient has developed prolonged ischemia, amputation may be necessary.

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