By Dr. P. C. Gupta
Vascular emergencies can be limb threatening or life threatening. These include sudden cessation of blood supply to the limbs (injury, thrombosis, embolism), rupture of aneurysm, bleeding due to injury, aortic dissection.
This section deals with embolism and thrombosis
When the blood supply to a limb is stopped suddenly, it results in pain followed by coldness, reduced sensation and paralysis. Unless the blood supply is restored immediately, there is a risk of irreversible tissue damage and limb loss. Sometimes, when alternative channels have formed previously, one may have more time to salvage the limb.
Signs and symptoms
Remember the 6 p’s
- Poikilothermia (coldness)
- Paraesthesia (abnormal sensations)
Decreasing pain often implies worsening of the condition due to nerve damage. Bluish discoloration also implies worsening prognosis. Anesthesia and paralysis are poor prognostic factors.
Arterial occlusions often result in anesthesia and paralysis and may be confused with neurological disorders. Examination of the pulses will usually clarify the cause.
What causes such occlusions?
These may result from embolism or thrombosis.
This refers to a clot breaking away from a lesion in the heart or large arteries aneurysms and lodging in a distant artery.
This implies sudden clotting of blood in an arterial segment. It may occur due to plaque rupture or due to a hypercoagulable state.
Embolectomy catheters used to remove emboli
HOW ARE THESE EMERGENCIES TREATED?
Once the patient reaches the hospital, a single dose of injectable anticoagulant is given to prevent further propagation of the clot. The vascular surgeon then decides further course of action.
If embolism is strongly suspected, immediate surgery, usually under local anesthesia is performed. The clot is removed using a balloon embolectomy catheter. Similarly, in most cases of limb trauma, one can immediately proceed with surgery.
In situations where the diagnosis is doubtful or injury is suspected at multiple levels, an emergency angiography is performed. Further treatment is planned based on the results of angiography.
The treatment could be in the form of a balloon thrombectomy, clot-buster therapy (a small catheter is placed in the thrombus and drug is injected to dissolve the clot) or a bypass.