Peripheral arteries can be acute with a thrombus, embolus, closed by an aortic dissection or acute compartment syndrome.
Acute peripheral arterial occlusion may result from:
Peripheral arteries can be acute with a thrombus, embolus, closed by an aortic dissection or acute compartment syndrome. Acute peripheral arterial occlusion may result from: rupture and thrombosis of an atherosclerotic plaque emboli from the heart or the thoracic or abdominal aorta aortic dissection Acute compartment syndrome (compartment syndrome) symptoms and findings are the sudden onset of the five Ps in a limb: severe pain (pain) , cold (polar sensation), paresthesia (paresthesias), paleness (pallor) and Pulslosigkeit (pulselessness). The closure can be allocated immediately distal of the last coarse pulse palpable arterial bifurcation (e.g., at the bifurcation of the femoral artery, when the femoral pulse is palpable;. At the popliteal bifurcation when the popliteal detect a pulse). Severe cases can lead to paralysis (paralysis). After 6-8 hours, the muscles can appear soft and mellow on palpation. The diagnosis is made clinically. An immediate angiography is necessary to confirm the location of the closure, to identify a collateral flow and to plan therapy. The treatment consists in the embolectomy (by catheter or surgical), thrombolysis or by-pass surgery. The decision for the surgical thromboembolectomy instead thrombolysis is made based on the severity of ischemia, the extent or location of the thrombus and the general medical condition of the patient. A thrombolytic (fibrinolytic) drug, especially when it is passed through a local infusion catheter is most effective in patients with acute arterial occlusion, which consists <2 weeks in which the motor and sensory function of the limb is intact. Tissue plasminogen activator (tPA) and urokinase are most commonly used. In this case, a catheter is advanced to the closure and given the thrombolytic drug in a form adapted to the patient size and extent of thrombosis dosage. The treatment usually lasts 4-24 hours, depending on the severity of ischemia and the signs of thrombolysis (relief of symptoms, return of pulses and improved blood flow Doppler sonography). Approximately 20-30% of patients with acute arterial occlusions require amputation within the first 30 days.