Occlusive thrombosis
An occlusive thrombosis is the complete blockage of an artery, with impaired circulation distal to the site of the blockage. Occlusive thrombosis can develop on any part of the body, on any vessel. Pathology is expressed in the absence of pulsation, in the paleness of the skin and pain. The victim is shown urgent medical care, in some cases, surgical intervention is required. Occlusive thrombosis is a condition that poses a direct threat to life or health. If the patient does not consult a doctor in time, he may lose a limb and become disabled.
Acute occlusive thrombosis is most commonly seen in men over the age of 60.
Depending on the location of the thrombus, doctors provide the following statistics:
- In 40% of cases, mesenteric vascular thrombosis is observed.
- In 35% of cases, occlusive thrombosis develops in the vessels of the brain.
- Limb arteries and aortic bifurcation are affected in 25% of cases.
- In 34% of cases, thrombus occlusion affects the femoral arteries.
- In 22% of cases, occlusive thrombosis affects the iliac arteries.
- In 9% of cases, popliteal arteries are affected.
- In 14% of cases, the pathology affects the subclavian vessels, the vessels of the shoulder and lower leg.
Content:
- Causes of occlusive thrombosis
- Symptoms of occlusive thrombosis
- Diagnosis of occlusive thrombosis
- Treatment of occlusive thrombosis
- Prevention of occlusive thrombosis
Causes of occlusive thrombosis
The cause of occlusive thrombosis is blockage of the lumen of a vessel or artery by a thrombus. It can be represented not only by a blood clot, but also by fatty, as well as tissue, microbial or tumor fractions.
Diseases against which occlusive thrombosis can develop are:
- Heart diseases: coronary artery disease, myocardial infarction, heart disease, arrhythmia, hypertension, atherosclerosis, aneurysm of the aorta and heart, inflammation of the heart muscle, dilated cardiomyopathy.
- Tumor neoplasm in the body: heart tumor, lung tumor.
- Congenital heart defects: open oval window, patent ductus arteriosus, cardiac septal defects.
- Diseases of the blood system: leukemia, polycythemia.
- Other pathologies: Takayasu's disease, periarteritis nodosa
Risk factors that can lead to occlusive thrombosis are:
- Postponed operations on arteries with their damage.
- Frostbite of body parts.
- Vascular spasm.
- Extravasal compression.
- Heart rhythm disorders.
- Blood pressure surges.
- Excessive physical or psycho-emotional stress.
- Taking medications.
- Physical inactivity.
- Forced sitting position for a long period of time, including work-related.
Sometimes doctors fail to establish the cause of the vascular blockage. A sharp weakening of blood circulation in that part of the body that receives power from the arteries subjected to occlusion is caused not only by the presence of the thrombus itself, but also by the spasm of the vessel. The fact is that with a weakening of the speed of blood flow through the clogged veins, it begins to increase its coagulation potential, and the walls of the artery continue to contract. This leads to the fact that the bypass paths of blood flow will also be blocked over time. As a result, the patient's condition will only worsen, and the ischemic lesions will worsen.
On the other hand, the clinical symptoms are enhanced by muscle edema, which increases against the background of the death of cells suffering from oxygen starvation. The damaged vessel itself loses its density, its permeability increases, which also leads to more pronounced edema of the affected area of the body.
So, the structure of the veins changed by trauma, injections or infectious processes, increased blood clotting and slowing blood flow are three factors that will contribute to the increase in the symptoms of pathology.
Symptoms of occlusive thrombosis
The symptoms of occlusive thrombosis directly depend on where the pathology develops. What matters is the stage of the lesion, the size of the thrombus, etc. The main signs that indicate occlusive thrombosis are as follows:
- Pain. It occurs in the area where occlusive thrombosis develops in 80% of cases. Although when the blood flow finds a workaround, pain may be absent or mild.
- The pain gradually increases, it is diffuse in nature. After the person has changed the position of the body, the pain does not subside. It can only pass when the occlusion is self-resolved.
- The artery, near the place where the blood clot formed, stops pulsing. The limbs that feed from the vessel gradually become paler, then acquire a bluish tint. A marble pattern appears on the skin. If you touch it, you can feel the cold.
- Occlusive thrombosis is always accompanied by numbness of the affected area of the body, there is a feeling as if goosebumps are running through the skin.
- If we are talking about the limbs, then they lose their muscle strength, the patient is not able to perform full movements with his leg or hand. As the symptoms increase, the paralysis increases more and more, bringing the patient to complete immobility.
- Nearby lymph nodes can increase in size and become painful.
- With a pronounced inflammatory process, a person's body temperature rises.
If the patient does not seek medical help, then he may develop gangrene, which will lead to the amputation of a leg or arm.
Diagnosis of occlusive thrombosis
Diagnosis of occlusive thrombosis requires an integrated approach, but always begins with examining the patient and taking anamnesis. The doctor necessarily probes the pulsation of the artery in the characteristic places. It is possible to carry out specific tests (Moshkovich's test, Panchenko's test, etc.).
Laboratory tests for suspected occlusive thrombosis:
- Taking blood for a general analysis, which allows you to confirm the presence of an inflammatory process in the body.
- Performing a coagulogram. Against the background of vascular occlusion, there is an increase in the prothrombin index, a jump in the level of fibrinogen.
- D-dimmer test, which makes it possible to diagnose thrombosis with a high probability.
Instrumental methods of examination of a patient with suspected occlusive thrombosis:
- Performing duplex scanning of vessels. This method will give information about the size of the thrombus, the degree of occlusion, the state of the vascular wall and how much the blood flow through the veins is disturbed.
- Peripheral arteriography.
- Undergoing computed tomography or MRI angiography.
It is imperative to distinguish between occlusive thrombosis with thrombophlebitis and abdominal aortic aneurysm.
Treatment of occlusive thrombosis
If there is a suspicion of occlusive thrombosis, then the patient must be urgently hospitalized. It must be examined by a vascular surgeon.
Drug therapy involves the appointment of thrombolytic drugs that are administered intravenously (Heparin). Fibrinolysin, Streptokinase, Streptodecase are used as fibrinolytics. In parallel, antiplatelet agents, antispasmodics are prescribed. If there is no threat to the patient's life, then he is sent to undergo physiotherapy treatment, but he is not discharged from the hospital. These can be procedures such as magnetotherapy, barotherapy, diadynamic therapy.
All this time, the patient must adhere to strict bed rest. To avoid the development of inflammation at the site of occlusive thrombosis, the patient is prescribed therapy with non-steroidal anti-inflammatory drugs. To restore the vascular wall, phlebotonics are needed: Antistax, Flebodia 600, Detralex, etc.
If after a day from the onset of occlusive thrombosis there is no improvement in well-being, then the doctor decides on surgical intervention (thromboembolectomy). If the patient develops necrotic tissue changes, then emergency limb amputation is indicated. Otherwise, the patient may die.
The prognosis for occlusive thrombosis largely depends on how soon the patient received medical attention. The sooner intensive therapy is started, the more chances of its successful completion are. As a rule, 90% of patients recover. If a person has delayed seeking medical help, then there is a high probability of amputation of the limbs, which are supplied with blood from the affected vessel, or even the death of the patient.
Prevention of occlusive thrombosis
Provided that a person is at an increased risk of occlusive thrombosis, or he has already suffered this pathology, he must adhere to the following recommendations:
- Wear compression garments.
- Take medications prescribed by your doctor. These can be anticoagulants, antiplatelet agents, phlebotonics. They are appointed by courses, or for life.
- Establish a diet, eat foods that do not increase blood cholesterol levels.
- Lead a healthy lifestyle, stop drinking and smoking.
- Increase physical activity, discuss with the doctor sets of exercises that can be performed without harm to health.
It is important to remember that only an urgent appeal for medical help will save a person's health and life. Therefore, even with the slightest suspicion of occlusive thrombosis, an ambulance should be called.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
