Arterial occlusion

Arterial occlusion is defined as a condition of acute lack of tissue perfusion due to sudden cessation of circulation. Main axial artery of the limb is blocked presenting within minutes to hour after occlusion.

1. e n love da Homoeopathy ARTERIAL OCCLUSION

2. ARTERIAL OCCLUSION

3. ARTERIAL OCCLUSION DEFINITION It is a condition of acute lack of tissue perfusion due to sudden cessation of circulation. Main axial artery of the limb is blocked presenting within minutes to hour after occlusion. COMMON SITES It is common in lower limb upper limb Also occur in mesenteric, cerebral, coronary arteries.

4. CAUSES Embolism is the most common cause in developing country. Trauma. Thrombosis of an artery polycythaemia rubra vera thrombocytosis. It is commonly observed in external iliac artery, profunda femoris artery and popliteal artery.

5. PATHOPHYSIOLOGY Distal ischaemia ↓ begins immediately after acute obstruction. ↓ Most sensitive peripheral nerves are first involved ↓ and then muscles, subcutaneous tissue and skin are affected in order. ↓ Irreversible ischaemia occurs in 6 hours. ↓ Golden period is 1–6 hours. ↓ Ischaemia may get aggravated by ↓ propagation of thrombus below and above the block ↓ occluding the orifices of collaterals ↓

6. fragmentation of embolus, associated thrombosis, acute compartment syndrome. Acute ischaemia causes endothelial injury of ↓ capillaries, arterioles and venules with luminal obliteration. ↓ Raised capillary permeability causes fluid leakage into extravascular space ↓ forming massive tissue oedema deep to deep fascia ↓ which by raising the intracompartmental pressure ↓ further reduces the perfusion leading into acute compartment syndrome.

7. CLINICAL FEATURES Pain which is continuous, severe, steady, bursting. Pallor of the distal part with extreme cold limb. Pulselessness —sudden loss of earlier palpable pulse. Paraesthesia—sensory disturbances like tingling, numbness or complete loss of sensation. PATHOLOGY

8. Paresis—damage to motor nerve and muscle leading into paralysis as a late grave feature. Poikilothermia —change in the temperature (cold). Pain, paraesthesia, paresis are due to ischaemia of peripheral nerves which are sensitive to hypoxia .

9. DUE TO TRAUMA/TRAUMATIC ACUTE ARTERIAL OCCLUSION CAUSES Thrombus due to trauma. Subintimal haematoma. Acute compartment syndrome. During femoral or brachial arterial catheterisation for either diagnostic or therapeutic procedures.

10. CLINICAL FEATURES History of trauma Pain Swelling at the site Pallor Pulselessness Cold limb. INVESTIGATION Duplex scan Angiogram TREATMENT Wound is explored and tear in the artery is identified. Proper antibiotics and heparin are required to prevent thrombosis of the vesseL ASSOCIAED FEATURES Immediate decompression by longitudinal fasciotomy Haematoma Vessel tear has to be managed accordingly

11. REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

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