What Is a Vaso-Occlusive Crisis?

Peripheral arterial embolism means that the peripheral arteries are blocked by a thrombus or emboli from a certain location, which then causes acute ischemia in the distal end, manifested as acute ischemic pain and necrosis, and directly affects the autonomy of life.

Basic Information

English name

peripheral arterial embolism

Visiting department

Vascular surgery

Common causes

Arterial emboli

Common symptoms

Pain, limb numbness, chills, disappearance or weakening of limb arterial pulse, etc.

Causes of peripheral arterial embolism

The main cause of acute peripheral arterial embolism is arterial emboli (thrombus or other types of emboli). The heart is the most common source of emboli. When combined with atrial fibrillation or mitral valve stenosis, left atrial blood flow disorder and slowed flow rate , Easy to form left atrial thrombus. Other heart diseases that can cause thrombosis include myocardial infarction, ventricular wall tumors, and cardiomyopathy; infectious thrombosis in patients with infective endocarditis comes from mitral or aortic valve vegetation; distal thrombus can also originate from Proximal aortic or aortic disease (such as aneurysms, atherosclerosis with ulcers). Rare cases are venous emboli that pass through an open oval foramen or ventricular septal defect and enter the arteries to cause embolism. In addition, calcified fragments from calcified valves, atherosclerotic cholesterol crystals, tumor plugs and other foreign bodies of malignant tumors can become emboli, but they are extremely rare. The following conditions can form arterial thrombosis in situ. A few cases of occlusive arteriosclerosis can occur with acute arterial embolism, while occlusive vasculitis and nodular polyarteritis are rare. In some blood abnormalities such as increased true red blood cell count Acute arterial embolism can occur in patients with dysfunction or cryoglobulinemia, although blood vessels are normal, but blood coagulability is increased. Arterial penetrating trauma, placement of arterial catheters and arterial bypass grafts, and non-cardiovascular diseases such as sepsis, pneumonia, peritonitis, and tuberculous ulcerative colitis may all cause arterial embolism.

Clinical manifestations of peripheral arterial embolism

The clinical manifestations of thromboembolism in peripheral arteries depend on the location, duration, and severity of the embolism. Acute arterial embolism can occur at any age. Embolism caused by rheumatic heart valve disease is younger, and those with coronary heart disease are older. In acute limb arterial embolism, the most common is iliac femoral artery embolism. Distal femoral artery.

Pain

Pain is the earliest symptom. Half of the patients experienced severe pain in the lower extremities after the onset. The nature is sharp pain, which radiates from the calf to the foot, and at the same time has the manifestation of tissue ischemia.

2. Feeling abnormal

The pain of the affected limb is accompanied by a feeling of numbness and coldness. The skin at the distal end of the embolism is weakened or disappeared, and the proximal side is hypersensitive, with acupuncture and tenderness. In the case of superficial arterial embolism, tenderness may be present at the site of the emboli.

3. Motor Dysfunction

Embolism leads to acute ischemia of limb muscles, fatigue and weakness during exercise, weakened muscle strength, paralysis in severe cases, and deep reflexes with pain disappeared when the limbs are passively moved.

4. Disappear or weaken arterial pulse

Due to the emboli blocking blood flow, arterial spasm and secondary thrombosis, the arterial pulsation at the distal end of the embolism disappears, such as femoral artery, iliac artery, dorsal foot artery, and posterior tibial artery pulsation disappear.

5. Skin changes

Ischemic skin changes generally occur below 10 cm at the embolization site, manifesting as pale skin, piebald-like, or cyanosis. Due to diminished or interrupted arterial blood supply, the venous blood is emptied, the skin temperature is low, there is a cold feeling, and the limb circumference is reduced. Skin changes and disappearance of pulse pulses are evidence of tissue ischemia.

In addition, when embolism occurs in areas with abundant collateral circulation, the symptoms may not be obvious, or intermittent claudication, but if the walking distance is shortened progressively, it indicates that the disease continues to worsen.

Peripheral arterial embolization

Color Doppler ultrasound

Determine the severity of limb ischemia and determine the approximate location of the embolism.

2. Magnetic resonance angiography

Judging the distal arterial outflow tract of the occlusion segment for preparation for arterial bypass surgery.

3. Angiography or digital subtraction angiography

It can provide the most detailed and accurate disease information, such as the location, extent, and extent of the lesion, and provide a basis for the choice of angioplasty or surgical method.

4. ECG and X-ray examination

Can understand the primary disease situation.

5. Echocardiography

It can provide the etiological basis for clinical diagnosis, and it can also be used for the etiology treatment to prevent re-embolization.

6. Laboratory inspection

It provides important reference for the assessment of ischemic degree and necessary preoperative preparation.

Diagnosis and differential diagnosis of peripheral arterial embolism

It is generally not difficult to diagnose peripheral arterial embolism based on the patient's underlying thrombotic disease (such as mitral stenosis, atrial fibrillation, mechanical valve implantation), a history of arterial embolism, sudden clinical symptoms, and corresponding ischemic signs. . The diagnosis needs to be clear: whether the artery is embolized, where the embolism is, and where the skin feels disappeared. The main differential diagnosis is acute arterial thrombosis.

Peripheral arterial embolization

1. Treatment of acute arterial embolism

Surgery is mainly used to remove thrombosis, and the principle of treatment is to actively control medical diseases, mainly heart failure, to improve heart function as much as possible to improve surgical tolerance; to operate as soon as possible to relieve limb ischemia; to observe closely after surgery to reduce perfusion injury Impact on the whole system.

Surgical complications are mainly ischemia-reperfusion injury, obvious swelling of the affected limb, and may be accompanied by manifestations of osteofascial compartment syndrome. Systemic manifestations of complications include metabolic acidosis, hyperkalemia, cardiopulmonary insufficiency, and acute renal failure.

2. Amputation

Patients with severe ischemic symptoms of irreversible muscle necrosis, calf muscle stiffness, swelling and skin necrosis should be amputated urgently.

3. Thrombolytic therapy

In some patients, surgery cannot be tolerated, and femoral artery puncture can be used for thrombolysis.

4. Interventional Therapy

A minimally invasive method is used to suck or mechanically remove the plug.

5. Medical treatment

Anticoagulation, dilation of the blood vessels, antispasmodic treatment can be given to alleviate the symptoms of the affected limb.

Peripheral Arterial Embolism Prevention

1. Active treatment and prevention of primary diseases that cause thrombosis is the key to preventing and treating peripheral arterial embolism.

2. In the process of catheterization and surgery, the technique should be gentle to prevent the plaque on the blood vessel wall from falling off or bringing in foreign bodies during operation to cause thromboembolism.