1. Acute arterial thrombosis and embolies
The cathedra of the faculty and hospital surgery of the treatment faculty of the Tashkent medical academy

2. Acute arterial impassability –
It is gathering notion, joining the diseases, that
Manifests with the ischemic syndrome
with the sudden stop or significant
Deterioration of the arterial flow
and creates the potential threat to its vitality

3. Acute arterial impassability
TRAUMA
EMBOLY
THROMBOSIS
SPASM
Acute arterial impassability

4. Emboly – this therm was introduced by
R.Virchov to note the situation when the
Thrombus is taken off from his formation
Place, passes by the vessel riverbed with
The blood flow and following closing of the
artery

5. Ischemic disease of heart
Cardiac rasons
Ischemic disease of heart
Rheumatic mitral vice
Septic endocarditis

6. Extracardiac
reasons
Ulcerous
atheromatosis

7. Left half of the heart
Near wall thrombus
Tumors
Vegetations at valve
БАКТЕРИАЛЬНЫЙ
ЭНДОКАРДИТ
Alien objects

8. Atherosclerotis cardiopathy
Acute infarct
Cardiosclerosis
Emboly
Defeat of the
rithm
Near wall
thrombus

9. Emboly Near wall thrombus Ischemic disease of the heart Acute infarct
Acute aneurism
of the left ventricule
Near wall
thrombus
Emboly

10. Mitral stenosis

11. Tumors of the heart MYXOMA Myxoma consist 30-50% of all primary tumors
In 86% cases myxoma is situated in the left atrium, in 90% - singular.
Embolic syndrome - 35% of ases.
Organs – dartboards for the tumor emboly – brain vessels, heart, kidneys, lower extremities, and the right part of the heart complicates with the emboly of the pulmonary artery.

12. MYXOMA
Tumors of the heart

13. Mechanism of the fragmentation of the intracardiac thrombus
Twinkle arithmy
Normal rithm

14. Reasons of the mobilization of the thrombus.
Increasing by the strength of the heart construction
Swing of the pressure in the cavities of the heart and aorta
Autolysis of the thrombotic mass
Hypercoagulation of blood

15. Meteorological tolerant

16. Aorta Aneurism Alien objects Sclerotic atheries Trauma with the
following thrombosis

17. Extracardiac embologeneous diseases
Aneurism of aorta and its branches

18. Ulcerous atheromatosis
Thrombus
Athery

20. 78,01% 21,99% Localization of the acute embolic complications
Emboly of the arteries
of the lower extremities
and aorta’s bifurcation
78,01%
Emboly of the arteries
Of the upper extremities
21,99%

21. Femoral artery
40,03%
Iliac artery
21,28%
Brachial artery
13,23%

22. Blood fullness of
the extremity
Line speed
of blood
flow
Volume blood flow
of the defeated
extremity
Perfusion
pressure

23. Pain in the defeated extremity
At the embolies the pain is sharp

24. The rule of 5 «Р»:
Pain
Рallor
Рulselessness
Рaresthesia
Рaralisis

25. I A I B I I A I I B III A III B III CIE
(ischemia of effort)
Absence of the signs of the ischemia in the
calm and appearance of them at the effort
Numbness
Coldness
Paresthesia
I A
I B
Pain
I I A
Paresis
Plegia
I I B
Subfuscial hypostasis
of the muscles
III A
Partial contracture
III B
III C
Total ontracture

32. Reducing of the skin temperature

33. Defeats of the sensitivity
If painful and tactile sensitivity are saved, the blood circulation is enough for the vitality of the extemity.

34. Subfascial hypostasis

35. Levels of definition of the pulsation of the arteries of the lower and upper extremities
A. AXILLARIS
A. BRACHIALIS
A. BRACHIALIS (bifurcation)
A. RADIALIS
A. FEMORALIS
A. POPLITEA
A. TIBIALIS POSTERIOR
A. DORSALIS PEDIS

36. Important moments at the definition of the pulsation of the main arteries
1 – define the pulsation at all points
2 – compare the fullness and effort in the symmetric
points of the collateral extremities

37. ПЕРЕДАТОЧНАЯ ПУЛЬСАЦИЯ
3 – separate the true pulsation from the transmition
ПЕРЕДАТОЧНАЯ ПУЛЬСАЦИЯ
ИСТИННАЯ ПУЛЬСАЦИЯ

38. 4 – at the palpation of the superficial arteries the embol
is frequently palpated
ЭМБОЛ

39. Place of embol’s localization
5 – at the spasm or ascending thrombosis the pulsation more proximal than embol isn’t defined
Place of the absence
of the pulsation
ЭМБОЛ
Place of embol’s localization

40. 6 – may define the pulsation lower than the level of occlusion
ЭМБОЛ
Localization of the occlusion
Presence of the pulsation

41. ЭМБОЛ
7 – at the disappearance of the arterial spasm the embol may migrate

42. there are cases, when the diagnosis may be stated with 100% accuracy:
If:
- AIE occur suddenly at the young man to 40 years
- without atherosclerosis
- with evident rheumatic vice of the heart
- with twinkle arithmy
Diagnosis of emboly isn’t doubtful.

43. It is necessary to think about the acute thrombosis
If:
- AIE occur slowly
- the patient is elder age
- suffering with the lamenss
- without evident disease of the heart
- without twinkle ariithmy
It is necessary to think about the acute thrombosis

44. Differential diagnostic of the AAI is carried out with:
- Acute stratification of the aorta
Acute venous thrombosis
Chronic critic ischemia
Obliterating endarteriitis
Acute transversal myelitis
Lumbar-sacral radiculitis

47. general symptoms of the AAI and acute stratification of the aorta:
-pain in the extremity
-defeat of the sensitivity
-absence of the pulsation
-pallor of the skin
-coldness

48. Different signs of the AAI and acute stratification of the aorta
Acute arterial impassability
Acute stratification of the aorta
Pain
Very intensive
Sudden sharp pain
Localization of the pain
In the extremities
In the back with the irradiation to the extremities
Defeat of sensitivity
At the kevel of coldness
Upper the level of coldness
Ischemia of the extremity
Sharp
Not so sharp
Movements of the extremity
defeated
saved
Skin
Pallor with the marble picture
pallor

49. general signs of the AAI and acute venous thrombosis:
-pain in the extremities
-hypostasis of the extremity
-numbness
-defeat of the sensitivity

50. Different signs of the AAI and acute venous thrombosis
Acute arterial impassability
Acute venous thrombosis
Age
Elderly
Young more often
Main diseases
Cardiosclerosis, mitral stenosis, twinkle arithmy
Birth, tumors of the pelvis, innate anomalies of vessels
Prodromal signs
Pain behind the sternum, defeat of the heart rithm
Lumbalr pain, cough, bleeding
Beginning of the disease
Always sharp
Slowly
Pain in the extremities
Often sharp
Extending character
Hypostasis of the extremity
Subfascial, limited only with shank, only at the III degree of acute ischemia
Total in all cases

51. Acute arterial impassibility Acute venous thrombosis Color of the skin
More frequently pallor with the blue tone, sometimes marble picture
Blue, the picture of subcutaneus veins is increased
Temperature of the skin
Hypothermia
Hyperthermia
Sensitivity
Hypoesthesia or anesthesia
Frequently not defeated (excluding the cases of “venous gangrene”)
Pain in the shank
At the ischemia III degree
At the most of the cases
Active movements of the extremity
Defeated, beginning from the II А degree
Limited at the large hypostasis
Pulsation of the arteries
It is torn off more distal than occlusion, upper is increased
Defined at the all duration of the extremity, at the large hypostasis is reduced

52. General symptoms of the AAI and acute transversal myelitis
-sharp begining
-pain in the extremity
-paresis
-plegia
-paresthesia

53. Different signs of the AAI and acute transversal myelitis
Acute arterial impassibility
Acute transversal myelitis
Anamnesis
Disease of the heart-vessel system
Inflammatory diseases of nerve system
Currency
Paresis, plegias
При ишемии II А,Б
В теч.1-2ч вялая
паралич н/к
Increasing of the temperature of the body
Seldom - subfebrilitet
To С
With fever and weakness
Reflexes
Save
Absence of the reflexes
Pulsation
More distal than occlusion
Saved

54. general symptoms at the AAI and lumbar-sacral radiculitis:
-pain in the extremity
-defeat of the sensitivity
-paresthesia
-defeat of movement of the extremities

55. 45% 55% 3 Gangrene Not liquidated occlusion not
Obligatory induct the loss of the
extremity 3
Chronic arterial
impassability
Gangrene
45%
55%

56. Tactic at the emboly Urgent operation IE II A I I B – III B
Embolectomy
May be carried
out after 24 hours
II A
Reconstructibe
operation
I I B – III B
+ fasciotomy
IIII A – IIII B
Urgent
operation
IIII C
Primary amputation

60. Tactic at the thrombosisIE
Thrombectomy
May be carried
out after 7 days
II A
Reconstructive
operation
May be carried
out after 48 hours
II B
III А
May be carried
out after 24 hours
III B
+ fasciotomy
IIII A – IIII B
Urgent
operation
Primary amputation
IIII C

61. Indications to the conservative treatment
COMMON STATE OF THE PATIENT AT THE LIGHT DEGREES OF
THE ACUTE ISCHEMIA
(ISCHEMIA OF EFFORT AND ISCHEMIA I-А DEGREE)
AND ABSENCE OF ITS PROGRESSING
AT THE ALL CASES OF DELAYS OF THE OPERATIONS
AS A PREOPERATIVE PREPARATION

62. pain LIQUIDATION OF THE PAIN 1—2 ml 2% solution of promedol or morphin
Liquidation of angiospasm
4 ml 1 % solution of no-spa
Or 2 ml 2% solution of papaverin
thrombus
Prevention of the development of
lasting thrombosis
15000 – UN of heparin.

63. Prevention of increasing
Metabolism in the
ischemic zone
Function of the
internal organs
Blood circulation in
The ischemic zone
improvement
Conservative therapy
Thrombus
Prevention of increasing
and spreading
Lysis

64. Reconstruction of the peripheral blood circulation and microcirculation
Enter of the toxic materials into the general blood flow
Development of the subfascial hypostasis
Deterioration of the ischemia and necrosis of the tissues
Intoxication and ARI

65. Fasciotomy of the shank
Indications:
Ischemia 3а degree.
Ischemia 3b degree.

66. Venous blood evacuation

67. Regional perfusion of the extremity
АИК
Perfusate:
NaCl 600,0ml
Papaverin
2%, 10 ml.
Novocain
0,25% 200ml
Streptasa 1mln
Heparin 10hund.

68. Haemosorbtion

69. plasmafaresis
Defogging of the blood from the toxic materials

70. Специальные раздвижные герметичные двери,
Absolute contraindications to the reconstructive surgical treatment
Специальные раздвижные герметичные двери,
модульные стеновые панели для чистых комнат,
герметичные потолки,
антистатические покрытия для пола,
системы чистого воздуха
- всё это гарантирует наилучший гарантированный результат
Agony state of the
patients
Total ischeemic
contracture of the
extremities (I 3B degree)
Extremely heavy state of the
patients at the light degrees
of the ischemia (II-I1B)

71. Operative access
Introducing of the Fogarty’s catheter into the practice allows effectively delete embols and lasting thrombus through the superficial arteries.

72. Amputation of the extremity is indicated:
At the 3 c stage of the acute ischemia and presence of the gangrene the primary amputation of the extremity is shown
at the unsuccessful trying of reconstruction of the main blood flow

73. Drills for the rotator atherectomy are covered with the diamonds

74. Сравнение роторной атерэктомии с обычной ангиопластикой в лечении бифуркационного стеноза