Acute Arterial Insufficiency Syndrome of the extremities

Acute limb arterial insufficiency syndrome. Clinical picture, produced by four main causes, that can suddenly interrupt arterial supply to an extremity, characterized by five findings: pain, paleness, coldness, functional impotence and absence of pulses; and that if it is not identified by the first doctor who sees it, it probably means the loss of the limb and with a great possibility life.

 

Summary

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  • 1 Clinical picture
    • 1 Pain
    • 2 Paleness
    • 3 Coldness
    • 4 Functional impotence
    • 5 Absence of pulses
  • 2 Causes
    • 1 Embolism
    • 2 Injuries
    • 3 Dissecting hematoma of the aorta
  • 3 Chronic diseases that slowly and steadily affect the arteries of the extremities
    • 1 Peripheral arterial disease
    • 2 Extracranial cerebrovascular arterial disease
    • 3 Aneurysms
    • 4 Diabetic foot
    • 5 Peripheral arterial disease (PAD)
    • 6 Venous
    • 7 Articulate
  • 4 Extracranial cerebrovascular artery disease
  • 5 Aneurysms
  • 6 Sources

Clinical picture

It is characterized by 5 symptoms and signs that appear suddenly and intensely.

Pain

Of sudden appearance, intense, strong, violent. It is not relieved in any position and is barely improved with the strongest pain relievers including opiates.

Pallor

Extreme, cadaverous. The limb seems dead in a patient desperate for his pain. After about 6 – 8 hours, areas of cyanosis appear, given the stagnation of the blood.

Within 24 hours, many of these areas become blisters. Its appearance is a serious prognostic sign: the limb is lost and presumably the life of the patient.

Coldness

Obvious, manifest. It is not a simple decrease in temperature. The closest similarity is touching the glass at the bottom of the refrigerator .

Functional impotence

The patient cannot move the muscles whose irrigation is interrupted since they do not receive “fuel”.

These symptoms and signs appear between 10 and 20 cm. below the occlusion.

Absence of pulses

It is the most important sign. There are no pulses below the occlusion site and at the same site, it is jumpy, fighting.

Causes

Embolism

60% of cases, of cardiac origin due to atrial fibrillation . His clinical picture is the most complete and obvious.

Thrombosis: History of intermittent claudication that passes to rest pain in a few minutes or hours, almost always due to instability of the atheroma.

Trauma

Arterial wounds, although in these the dangerous clinical picture of hemorrhage and shock predominates.

Dissecting hematoma of the aorta

Severe clinical picture that simultaneously resembles cardiac infarction and acute ischemia from one or more locations.

Chronic diseases that slowly and steadily affect the arteries of the extremities

Peripheral arterial disease

A term that particularly identifies steno-occlusive diseases of the arteries in the extremities, preferably in the lower ones, from the abdominal aorta, whose leading entity in more than 90% of cases is atherosclerosis obliterans.

Extracranial cerebrovascular artery disease

Group of entities that affect the carotid and vertebral arteries and determine conditions that fluctuate from transient cerebral ischemia to cerebral embolism or terminal thrombosis, in which atheromas generated by atherosclerosis obliterans are also the most important causes.

Aneurysms

Unlike the two previous locations, the disease does not lie in stenosis, but in dilation. They constitute arterial diseases due to dilation or ectasiants, with their preferential location in the abdominal aorta, almost always with extension to the iliac ones.

Diabetic foot

Diabetes has the peculiarity of making the large and small vessels sick. Vascular disease is conjugated with neuropathy and infection and together they frequently involve the foot, the lower limb and life.

In the case of the great vessels, diabetes develops atherosclerosis with clinical characteristics different from those without diabetes. It is an earlier, more intense, more extensive, more diffuse and more severe atherosclerosis than that of the non-diabetic patient. The severe combination in diabetes of different degrees and severity of macroangiopathies and microangiopathies, neuropathy with plantar ulceration and ease of infection, determine different classifications and therefore different behaviors in each patient.

Peripheral arterial disease (PAD)

As was said, it is the stenosis and occlusion of the arteries of the extremities, particularly the lower ones, and is characterized by intermittent claudication, defined as “gait arrest due to muscle pain that is spontaneously and slowly relieved when stopping. He stops, he relieves himself, he walks again and he stops again. ” So it is claudication and intermittent.

The limb that suffers from claudication has its deteriorated anatomy, from the skin and legs, to its muscles. The most important sign on physical examination is the decrease or absence of arterial pulses, so the young doctor must expressly look for them in all examined patients.

It is worrying that the newly promoted doctor frequently assumes, out of ease or overconfidence, that all peripheral pulses are present, which is not the case. The physician must determine the presence or absence of the peripheral pulses in any physical examination. The main cause of PAD is atherosclerosis obliterans. Other claudications of the lower limbs must be differentiated:

Venous

The patient reports, more than pain, a feeling of tiredness and heaviness that increases when he walks and especially when he stands. He is relieved when he sits down and raises his limb, accompanied by an Ah! of relief. It is a carrier of varicose veins .

Articulate

It occurs in patients of legal age. Morning pain that the patient refers to as “getting up grounded” for having pain in their joints and relieving themselves “when warming up”, as the day goes by. His joints also hurt during changes of position: sit, sit up, lie down.

In these claudications pulses in the limb are present. All three with very frequent causes of consultations in the community and it is necessary to differentiate them.

Extracranial cerebrovascular artery disease

Atherosclerosis of the carotids leads to fleeting amaurosis and pictures of transient attacks of cerebral ischemia (ATI), a true simile in the eye and brain, of intermittent claudication to gait in the lower limbs. It is mandatory in every doctor to listen to the carotid arteries in every patient with fleeting amaurosis or ATI.

Aneurysms

The abdominal aortic aneurysm (AAA) is a tumor located in the abdominal midline, somewhat to the left, which beats, expands, and almost always has a systolic murmur. AAA is asymptomatic, degenerative, frequent, appears in 10% of people 60 years of age or older, and reaches 15% among those of the fourth age. It is predominantly due to the masculine sex, the white race, fusiform and of a preferred infrarenal location, in which case it is well delimited from the costal margin.

Since it is asymptomatic, silent, every doctor should specifically palpate the forgotten midline of the abdomen in any abdominal exam, particularly in people around the elderly.

 

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