ZAPOROZHYE STATE MEDICAL UNIVERSITY CHAIR OF HOSPITAL SURGERY ASSISTANT PROFESSOR KLYMENKO A.V. ACUTE ARTERIAL OBSTRUCTION

Sudden stop of the blood flow in great vessel becouse of thrombosis, embolia, spasm, trauma.

Ethiology of thrombosis Thrombotic diseases Atherosclerosis Buerger Disease (Thromboangiitis Obliterans) Takayasu Arteritis (Non-specific aortoarteritis) Virchov triad hypercoagulation Intimal injury Turbulent blood flow

Embologenic diseases Cardial (95%): Ischaemic heart disease (50%) – myocardial infarction, arrhythmia (ciliary arrhythmia (atrial fibrillation), extrasystole, etc.), heart aneurysm. Heart malformation (40%). Myocarditis, endocarditis, pneumonia (5%) Non-cardial (5%) – aortic aneurysm.

Pathogenesis of acute ischaemia Sudden stop of the blood flow in great vessel. Periferal vasospasm. Blood stasis. Prolonged thrombosis – ascendal and descendal. Developping of acute inflammation in intima. Venouse tgrombosis. Hypoxia, metabolic acidosis. Hyperkaliemia, «Myoglobinuric nephrosis».

Classification by Savelyev (1974) 1А – paresthesia, numbness, coldness. 1B – pain. 2А – paresis. 2B – paralysis. 3A – subfascial oedema. 3B – partial muscul contracture. 3C – total muscul contracture.

Evolution of the stenosis The thrombus develops in the stenosed zoneThe thrombus develops in the stenosed zone

Localisation of embolic lesions Emboli are getting fixed in arterial bifurcationEmboli are getting fixed in arterial bifurcation

Localisation of embolic and thrombotic lesions

Diagnostics of acute ischaemia Complaints and anamnesis Clinicaly: Paleness of the extremity Hypothermia Paresis, paralysis Disappearance of the puls Gutter-sympton Doppler ultrosound Angiography

Paleness of the extremity, collapsing veins

Mottled skin

Acute ischaemia paresis paralysis

Treatment before hospitalisation Spasmolytics – no-spa, papaverin (liquidation of periferal vasospasm). Analgetics – non-narcotic or narcotic. Anticoagulation – heparin ED, for prevention of continued thrombosis Hospitalisation into angiosurgery dept.

Indications to angiography: Not clear clinics of the disease. In inconsistency between the level of occlusion and the level of ischaemic tissue. For the purpose of differentiation between different forms of acute ischaemia. In case of plural or many-storied Ljng lasting disease In case of ischaemia saving after the oparation

Angiography

The baseground of the tactics The term The localisation The degree of the ischaemia The stay of a patient Reconstruction is contrindicated in: Agony III degree of ischaemia Ia, Ib degree of ischaemia in hard condition of a patient

Intraarterial infusion

Aorta-bifemoral shunting

Femoral-popliteal shunting

Plastics of the profound femoral artery

Kinds of thrombectomy Direct Non-direct: Antegrade Retrograde

Embolectomy by catheter Fogarty

Direct embolectomy

Embolectomy from aorta

Antegrade embolectomy

Approuch to the popliteal artery

Retrograde embolectomy

Types of vascular injury

Mechanism of the vascular injury

Angiography in vascular injury

Surgery Initial surgical treatment Vascular repare Side or circular stitch Plastics In case of defect 1-3 cm - anastomosis In case of defect more than 3 cm – prostethics with autovein of artificial graft

Types of the operations

The rate of healing patients depends of time and level of acute ischaemia