Why is the artery blocked?
There are two main mechanisms. An embolism is a clot brought by the bloodstream from another place, most often from the left atrium in atrial fibrillation, from the area of infarction, or from an aortic aneurysm. Such a clot gets stuck at the branching site of the artery, and symptoms develop instantly against the background of previously healthy vessels. Thrombosis - the formation of a clot directly on a damaged atherosclerotic plaque; it is usually preceded by intermittent claudication, and thanks to the bypass vessels, the symptoms increase slightly more slowly.
- Embolism from the heart with atrial fibrillation
- Thrombosis on an atherosclerotic plaque
- Thrombosis of popliteal artery aneurysm
- Aortic dissection
- Thrombosis of a previously installed shunt or stent
- Artery injury
Causes and risk factors
The most common source of emboli is the heart. Atrial fibrillation without taking anticoagulants, a major heart attack with a thrombus in the ventricular cavity, prosthetic valves and infective endocarditis sharply increase the risk. From the vascular side, widespread atherosclerosis, aneurysms, and previously performed vascular operations are important. A separate group consists of blood clotting disorders, dehydration, cancer and prolonged immobility. Smoking aggravates all of these mechanisms.
- Atrial fibrillation without anticoagulants
- Previous myocardial infarction
- Atherosclerosis of the leg arteries
- Aneurysm of the aorta or popliteal artery
- Thrombophilia and cancer
- Dehydration and prolonged immobility
- Smoking and diabetes
Symptoms
The classic picture is described by a set of signs: severe pain, pallor, absence of pulse, coldness, impaired sensitivity and movement. At first the pain is very intense, then as the nerve endings die, it can paradoxically decrease - this is an alarming, not a favorable sign. Later, the skin acquires a marbled and then bluish tint, dense muscle swelling and blisters appear. Loss of movement in the foot means that the clock is counting, not the day.
- Sudden sharp pain in the leg
- Pale, then marbled skin
- Cold extremity
- Disappearance of pulse in the foot
- Numbness and decreased sensitivity
- Weakness and inability to move the foot
- Dense swelling of the lower leg muscles
Diagnostics
The diagnosis is mainly clinical: the doctor compares both legs, assesses temperature, color, sensitivity, movement and checks the pulse at all levels. Duplex ultrasound scan confirms the level of blockage right at the patient's bedside. If the condition allows and reconstructive surgery is planned, CT angiography or angiography is performed. At the same time, they are looking for the cause: they do an ECG and echocardiography to find the source of the embolus, take a coagulogram, evaluate kidney function and potassium levels before restoring blood flow.
- Examination to check pulse, sensation and movement
- Duplex scanning of arteries
- CT angiography when planning surgery
- ECG and EchoCG to find the source of the embolus
- Coagulogram
- Blood biochemistry, potassium, kidney parameters
Treatment and prevention of recurrences
Before the ambulance arrives, the leg should not be warmed, rubbed or massaged: heat increases the tissue’s need for oxygen and accelerates its death. The limb is left alone, slightly lowered, and covered with a light cloth. In the hospital, an anticoagulant is immediately administered and blood flow is restored: removal of the clot with a special catheter, shunting or dissolution of the clot through a catheter. After the operation, the cause must be eliminated - constant anticoagulant therapy for arrhythmia is selected, atherosclerosis is treated, and smoking cessation is recommended.
- Immediately call an ambulance by number 103
- Do not heat, rub or massage your leg
- Anticoagulants from the time of diagnosis
- Thrombembolectomy with catheter
- Arterial bypass or stenting
- Catheter thrombolysis in selected cases
- Lifelong prevention: anticoagulants, arrhythmia control, smoking cessation
