Acute ischemia and its common causes
Acute ischemia is the sudden and abrupt interruption of arterial blood supply to an organ or limb. It may be due to different reasons, although the most frequent causes of acute ischemia are:
- Arterial embolism: a clot is formed, usually from the heart, due to a valvulopathy or arrhythmia, and depending on the size of the clot, it becomes lodged in a bifurcation of the arterial tree.
- Arterial thrombosis: the formation of a thrombus in previously diseased areas of the arteries due to arteriosclerosis or chronic ischemia, among other causes.
- Arterial trauma: this is a section or lesion of the artery by direct trauma, either by the action of a bone in case of fracture, by a firearm, knife, etc…
Warning symptoms of acute ischemia
The cessation of arterial flow will cause the following symptoms, presented in order of appearance:
- Coldness
- Pallor
- Intense pain
- Paresthesias or tingling
- Subcyanosis or obtaining blue tone in the area
- Paralysis
- Anesthesia
It is very important to act quickly in the case of acute ischemia: when symptoms appear, immediately consult a vascular surgeon to obtain a diagnosis of the disease and proceed to the most appropriate treatment.
How to diagnose acute ischemia
The diagnosis of acute ischemia is based basically on a physical examination with findings of coldness, temperature asymmetries, lack of pulses or pallor.
The non-invasive diagnosis of ischemia is made by performing an Echodeppler ultrasound to determine the state and blood flow of the artery.
Angio-CT or MRI angiography can also be performed, since these diagnostic tests provide a global analysis of the entire arterial tree that allows subsequent planning of possible treatment.
Appropriate treatment for acute ischemia
In cases of embolism and arterial trauma, vascular surgery treatment will be required, using Fogarty catheter-probe embolectomy techniques, a method that consists of an incision in the artery to extract the embolus.
In cases of arterial trauma, it will usually require repair by direct suture or bypass, thus saving the injured area.
In cases of suspected arterial thrombosis, when the patient has a history of claudication on walking, a large number of vascular risk factors such as smoking, hypertension or diabetes, the most prudent thing to do, after a non-invasive examination with Ecodoppler, is to perform an armed arteriography with the intention of treating and catheterizing the artery. Thus, by means of endovascular techniques such as guidewires, balloons or stents, the ischemia can be resolved.
In those cases in which it is not feasible to perform it by means of minimally invasive endovascular techniques, it is always possible to resort to classic bypass surgery by means of autologous prosthesis, that is to say, from the patient’s own vein, or heterologous or synthetic prosthesis.