Arterial blood supply disorder

Introduction Arterial embolism is a blood clot or a foreign body that enters a blood vessel to become an embolus. As the blood flow rushes and stops in an artery of similar size to the embolus, causing arterial occlusion, causing clinical manifestations of acute ischemia. It is characterized by rapid onset, obvious symptoms, rapid progress, and serious prognosis, which needs to be actively treated. The clinical manifestations of acute arterial embolization can be summarized as 5 "P": pain, paresthesia, paralysis, pulselessness, and paleness.

Cause

Arterial embolism is mainly caused by blood clots. In addition, foreign bodies such as air, fat, cancerous plugs, and catheter breaks can also become emboli.

The main sources of emboli are as follows:

1 cardiogenic, such as rheumatic heart disease, coronary sclerosing heart disease and bacterial endocarditis, thrombus detachment of the ventricular wall, thrombus detachment on the artificial heart valve.

2 vasogenic, such as aneurysm or thrombus in the artificial vascular lumen, atherosclerotic plaque detachment.

3 iatrogenic, arterial puncture cannula catheter broken into foreign bodies, or intimal tears followed by thrombosis and shedding. Among them, cardiogenicity is the most common. The embolus can be flushed into the brain, internal organs and limb arteries with DC. Generally stay at the arterial bifurcation. In the peripheral arterial embolization, the lower limbs are more common than the upper limbs, followed by the common femoral artery, the common iliac artery and the active bifurcation of the abdomen; in the degenerative limbs, the radial artery, the radial artery and the subclavian artery are in turn.

The main pathological changes are: early arterial spasm, endothelial cell degeneration, arterial wall degeneration, secondary thrombosis in the arterial lumen, 6-12 hours after severe ischemia, tissue necrosis, muscle and nerve function loss.

an examination

Related inspection

Blood pressure arterial oxygen partial pressure (PaO2) arterial blood oxygen content (CaO2) blood oxygen content

1. Fever, general malaise, loss of appetite, sweating, paleness, may be associated with arthritis and nodular erythema.

2. Local performance:

(1) Head and arm arterial type: upper limbs are prone to fatigue, pain, numbness or cold feeling, facial muscle pain during chewing, emotional excitement, dizziness, headache, memory loss, irritability, vision loss and transient black eyes . The pulsation of arteries such as unilateral or bilateral iliac, iliac crest, iliac crest, or iliac crest is weakened or disappeared, while the pulsation of the lower extremity is normal, the upper extremity blood pressure is not measured or significantly reduced, or the difference in systolic blood pressure between the two arms is > 2.67 kPa (20 mmHg). Lower limb blood pressure is normal or increased. Persistent or systolic murmurs can be heard in narrow blood vessels.

(2) Thoracic and abdominal aortic type: lower extremity numbness, pain, cold feeling, fatigue, intermittent claudication, upper extremity blood pressure continued to increase, may have various symptoms of hypertension, weakening or disappearing of one or both sides of lower extremity arteries Blood pressure can not be measured or significantly reduced, upper limb blood pressure is increased, systolic murmur can be heard in the abdomen or kidney area, and there may be signs of left ventricular enlargement or acute left heart failure.

(3) Renal artery type: persistent, severe or stubborn hypertension, and various symptoms caused by high blood pressure. The blood pressure of the extremities was significantly increased. There may be signs of left ventricular enlargement or left heart failure, and systolic murmurs may be heard in the upper abdomen or kidney.

(4) Pulmonary artery type: simple pulmonary artery type may have no obvious symptoms, and severe cases may have purpura, palpitations, and shortness of breath. Pulmonary valve area, sacral and dorsal systolic murmurs, pulmonary hyperplasia of pulmonary artery and other pulmonary hypertension.

(5) Mixed type: the lesion involves the above two or more groups of blood vessels. Most patients have significant hypertension, and other manifestations vary with the vessel involved.

Differential diagnosis

First, acute arterial thrombosis

Clinically, it is very difficult to identify acute arterial embolism and atherosclerosis secondary thrombosis, but the identification of the two is very important. The use of balloon catheterization is safe and effective. However, thrombectomy (thrombectcmy) often fails, and may also expand the scope of obstruction. Arterial thrombosis has long-term symptoms of insufficient blood supply, such as numbness, chills, and intermittent claudication. There were skin, nail and muscle atrophy lesions at the time of examination. The onset was not as rapid as arterial embolism, and there were often prodromal symptoms of vascular insufficiency for some time. Arterial angiography showed that the wall of the affected artery was rough, not smooth or distorted, narrow and segmental obstruction, and there were more collateral circulations around it, which were distorted or spiral. Note that these are helpful for differential diagnosis.

Second, acute deep vein thrombosis

Acute patellofemoral phlebitis and blue-swelling patients may cause arterial reflex spasm, weakening or disappearing of distal arterial pulsation, lower skin temperature, pale skin, limb edema, and misdiagnosis as arterial embolism. Edema is often a late manifestation of severe arterial insufficiency, with obvious ischemia of the skin and muscles occurring, but most severe edema of thrombophlebitis occurs before skin necrosis. At the same time, there are superficial varices, skin color cyan, etc., easy to differentiate with arterial embolism.

Third, arterial intimal separation

Arterial intimal separation causes intracavitary pseudosinus compression of the arterial lumen may be accompanied by distal arterial embolization. However, these patients often have chest and back pain, a history of long-term hypertension, auscultation with murmurs, and chest radiographs with mediastinal widening to help diagnose.

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