Interventions on the coronary arteries with multivessel disease

Occlusion of the femoral artery is a violation of its patency (blockage).

As a result of the occlusion, arterial, oxygenated blood stops flowing to the lower leg. Ischemia develops (local anemia).

Femoral artery occlusion occurs mainly in men. Persons over 50 years of age account for up to 75% of cases of the disease.

Femoral artery occlusion can be:

• segmental, affecting only a limited area of ​​the artery;
• complete, when the entire artery is affected;
• combined with occlusions of other arteries of the lower extremities.

General information

Vascular occlusion is a blockage (more often of arteries than veins), which is characterized by a pronounced decrease in the speed and quality of blood flow. Occlusion can cause necrosis and, as a result, lead to death.
The pathology is quite common and can affect the organs of visual perception, the central nervous system, limbs and great vessels. sepsis and peritonitis develop . Abdominal ischemic syndrome develops against the background of a lack of adequate blood circulation in the digestive tract. The pathology is associated with occlusion of the unpaired visceral branches of the abdominal aorta - the celiac trunk and mesenteric arteries (superior, inferior). Abdominal toad can develop under the influence of both internal ( thrombosis ) and external factors (traumatic occlusion).

What is an occlusive dressing?

This method of sealing the lesion is used for wounds that require maintaining sterile conditions and protection from the external environment.

Applying an occlusive dressing to the knee joint requires certain skills and technique:

• cover the wound surface with sterile gauze;
• Place the top of the scarf on the thigh area and wrap it around the waist;
• bend the bandage at the base by 2 cm;
• cross the ends under the thigh, tie knots on the thigh;
• Throw the top over the knot formed and then pass it under the knot.

What else causes stenosis?

More rare cases are associated with a specific pathology. Narrowing of the arterial vessel is observed with a disease of the connective tissue that forms the stroma of the artery. This is called fibromuscular dysplasia - the vessels cease to maintain tone and collapse, stopping blood flow. Stenosis can accompany some inflammatory diseases of the vascular wall - arteritis, systemic vasculitis, Takayasu's disease, Horton's disease. There are rare pathologies, for example moyamoya disease, in which there is a slow progressive narrowing of the lumen of the arteries.

Stenosis can occur after an injury - a strong blow, a concussion. After some traumatic brain injuries, a special hematoma is observed - subintimal, which has the appropriate localization. A blood clot that forms due to increased blood clotting and rare types of anemia can block the lumen. There is antiphospholipid syndrome, in which young patients experience heart attacks and strokes precisely because of increased coagulation. Blood clots form when heart rhythm disturbances occur while taking certain medications.

The narrowing may be due to congenital structural features of the vessels - they can be tortuous and hypoplastic. Vascular pathology accompanies systemic diseases, diabetes, obesity and metabolic disorders.

Pathogenesis

When the blood thickens, there is an accumulation of fibrin in its composition, which leads to thrombus formation . Venous formations are characterized by constancy - they are located in one area and clog the vessels of the extremities, leading to necrosis and gangrene . Arterial formations are characterized by migration; they often break away from the original source and disrupt the blood supply to large organs, provoking the development of stroke , heart attack and other dangerous conditions.

Classification, types of occlusion

It is customary to distinguish between arterial and venous occlusion.

Types of occlusion by localization:

• Occlusion of mesenteric vessels . It is characterized by an acute circulatory disorder in the mesenteric vessels, which inevitably leads to intestinal ischemia. As a result of thrombosis, the trophism (nutrition) of the intestinal walls is disrupted, and an acute inflammatory process develops, including peritonitis .
• Occlusion of cerebral vessels. The gradual growth of cholesterol plaques in volume can lead to complete blockage of the vessels supplying blood to the brain. The vessels lose their elasticity and a blood clot forms at the site of attachment of the cholesterol plaque as a result of platelets adhering to the damaged vascular wall.
• Occlusion of the arteries of the lower extremities. In this case, a sharp closure of the lumen of the peripheral artery and the development of an acute form of ischemic syndrome are characteristic. Such changes lead to disruption of trophism and nutrition of the lower extremities, paralysis and even gangrene . With occlusion of the femoral artery, extensive circulatory disorders develop not only in the lower extremities, but also in the pelvic organs, which can pose a real threat to the life and health of the patient. Both the superficial (SFA) and deep femoral artery can be affected.
• Occlusion of cardiac vessels. Damage to the coronary arteries is very common. When the supply vessel is completely blocked, irreversible consequences develop in the form of necrosis - myocardial infarction . ischemia develops , which manifests itself as signs of angina pectoris . The blockage can occur due to a blood clot or atherosclerotic plaque. With long-term, chronic occlusion, bypass pathways are formed - collaterals, through which nutrients are supplied. In 98% of cases, the coronary arteries are affected by atherosclerosis .
• Occlusion of the subclavian artery. As a result of blockage, ischemia occurs not only in the upper extremities, but also in the brain. Dizziness , weakness in the arms, problems with speech and visual perception appear The consequences of occlusion of the subclavian arteries are severe.
• Occlusion of the carotid artery. There is both complete and partial blockage of the vessels that supply blood to the brain. Occlusion of the internal carotid artery, which nourishes and supplies the brain and is responsible for intracranial circulation, is rare. Damage to the common carotid artery can lead to problems with visual perception.
• Occlusion of the iliac artery. The first manifestation of the lesion is numbness in the legs, fatigue, ischemia of the legs, and the appearance of pain when walking. Gradually, damage manifests itself in the functioning of the pelvic organs, impotence , and the functioning of the abdominal organs is disrupted.
• Occlusion of the eye or occlusion of the retinal artery. It is extremely rare. It is characterized by a completely asymptomatic course and a sudden deterioration in vision up to complete blindness.

Occlusion in dentistry

In dentistry, occlusion is closure, i.e. the most complete and dense contact of the chewing surfaces with each other. In simple words, dental occlusion is the relationship of the jaws relative to each other.

The occlusal surface of the tooth is that part of the tooth surface that is located from the deepest part of the central fissure to the top of the cusps.

6 keys of occlusion according to Andrews

Andrews is credited with formulating his own theory based on crown morphology and evaluating 120 models with “ideal” occlusion in orthodontically untreated patients. He developed rules (keys) for the relationship of a single tooth to both the adjacent and the antagonist tooth, taking into account its position.

• Key 1 – ratio of painters;
• Key 2 – mesiodistal type (crown angulation);
• Key 3 – torque and inclination of tooth crowns;
• Key 4 – rotation;
• Key 5 – contact point;
• Key 6 – Spee curve.

Central occlusion

The definition includes other names:

• intertubercular contact;
• maximum closure of teeth;
• intertubercular contact position;
• intercuspation.

Central occlusion determines the position of the lower jaw, which is characterized by:

• uniform, symmetrical contraction of the muscles that raise the lower jaw;
• the central position of the heads of the temporomandibular joint in the articular fossae;
• maximum fissure-tubercle contacts of the dental rows.

Dental signs of central occlusion:

• Between the teeth of the lower and upper jaws there is the most dense tubercle-fissure contact.
• Each tooth intersects with two antagonists. The only exceptions are the lower central incisors and upper third incisors.
• The midlines between the central lower and upper incisors are located in the same sagittal plane.
• The lower teeth overlap the upper teeth by no more than a third of the length of the crown in the frontal region.
• The cutting edge of the lower incisors contacts the palatal cusps of the upper incisors.
• The upper first molar occludes the 2 lower molars, covering two-thirds of the first molar and one-third of the second.
• The buccal cusps of the lower teeth overlap the buccal cusps of the upper teeth in the transverse direction.

You can learn more about occlusion in dentistry in the book “Functional Occlusion” by Peter Dawson.

Treatment methods for central retinal artery thrombosis

Treatment of occlusion must begin literally in the first hours after complaints about the absence or decrease in vision, otherwise it will be impossible to restore it. Primary emergency care should include massage of the eyeball, which will help restore blood flow to the central nervous system. To reduce IOP, instillation of eye drops, the use of diuretics, and corneal paracentesis are recommended.

If occlusion of the central retinal artery is caused by spasm of the arterioles, pathogenetic therapy is supplemented by the appointment of vasodilators (sublingual nitroglycerin, intramuscular papaverine, intravenous aminophylline, etc.), carbogen inhalation or hyperbaric oxygenation.

In case of thrombosis of the central nervous system, it is necessary to use thrombolytic agents and anticoagulants, intravenous infusions of dextrants, and probing of the branches of the ophthalmic artery through the supraorbital artery.

Any type of central artery occlusion requires the use of antioxidants, local retrobulbar and parabulbar injections of vasodilators, and instillation of b-blockers. At the same time, corrective therapy for concomitant systemic pathology should begin.

The effectiveness of treatment of central retinal vein occlusion directly depends on the efficiency of its implementation and is especially high in the first hour from the moment of thrombosis.

Causes

Most often, occlusion develops as a result of embolism, blockage of a blood vessel by a dense formation. This process can develop as a result of:

• Infectious disease . In this case, the blood flow is blocked by inflammatory-purulent blood clots or the accumulation of a large number of pathogenic microorganisms.
• Air embolism . It develops as a result of an air bubble entering the systemic bloodstream. It is determined after traumatic damage to a vessel or after an incorrectly performed injection.
• Fat embolism . As a result of metabolic , fat particles accumulate and a fat clot forms from them.
• Arterial embolism . Thrombi form on the valve apparatus of the heart and are characterized by instability and mobility, which can lead to separation of thrombotic masses and blockage.

Occlusion of the vessels of the neck and coronary arteries is formed in the area of ​​their branching or narrowing.

Causes of thrombosis:

• malignant neoplasms;
• atherosclerosis;
• traumatic injuries;
• aneurysms;
• thromboembolism.

As a result of traumatic damage to muscle tissue and the skeletal system, compression occurs and blood flow is blocked.

Prevention

Distal occlusion develops in childhood. Attentive parents can prevent the development of irreversible changes. Prevention of postural disorders, timely treatment of diseases of the ENT organs, fight against bad habits, early treatment of caries of primary teeth will prevent deformation of the facial skeleton and improper growth of teeth. If violations are detected, you need to make an appointment with the orthodontist as soon as possible. The younger you are, the easier it is to correct your bite.

Symptoms

Against the background of damage to the brachiocephalic vessels, there is a decrease in performance, weakness and dizziness . The brachiocephalic trunk is responsible for the blood supply to the soft tissues of the head and the brain. If the left artery is additionally involved in the pathological process, then the clinical picture worsens significantly. Main manifestations:

• pale skin;
• nausea;
• headache;
• pain during physical activity;
• confusion;
• paraplegia;
• swelling and development of necrosis;
• burning sensation or numbness;
• deterioration of visual perception;
• hallucinations;
• difficulty breathing, swallowing;
• speech disorders;
• cardiopalmus;
• absence of pulse in the affected area.

If any of the above symptoms appear, it is necessary to conduct a thorough analysis and diagnosis to identify the true cause and subsequently prevent the development of severe complications.

How to diagnose pathology?

To diagnose abnormal clamping of the CC pathways, a comprehensive neurological examination is performed. The most accessible technique is ultrasound screening of head and neck vascular tissues. The most informative method confirming the initial diagnosis is angiography of cerebral vessels. Angiography is used in difficult cases, as well as before instrumental intervention (for planned surgery).

Magnetic resonance angiography is as safe and informative as possible due to the inaccessibility of other diagnostic methods. Additionally, a referral is made for a nuclear resonance scan of the brain. With joint hardware diagnostics, damage to the carotid “traces” is 100% detected.

Computer scanning helps to identify areas affected by oxygen deprivation. Color differences in degenerative areas in the resulting images help differentiate different types of ischemia. This type of disease can be determined only after 2-3 days. In the first hours of ischemia development, changes in brain tissue are not visible. Destruction can be determined only by indirect signs.

Tests and diagnostics

It is recommended to consult a doctor at the first manifestations of the disease. After examination, collecting anamnesis and assessing the manifestations of clinical symptoms, they begin diagnostics, which includes:

• CT arteriography;
• Doppler ultrasound;
• cerebral angiography;
• MR angiography;
• coagulogram;
• MRI of the brain.

Only after a comprehensive examination is appropriate treatment prescribed, which is selected individually for each patient.

Diet for occlusion

To restore the elasticity of the vascular wall, strengthen it and reduce the severity of occlusion, it is recommended to adhere to certain dietary rules. In case of occlusion, it is recommended to adhere to a special cholesterol-lowering diet, which includes:

• Legumes . Beans and legumes are sources of protein, iron, folic acid and contain absolutely no fatty acids.
• Whole grains (wheat bread, buckwheat, oatmeal and brown rice).
• Cabbage (all types, especially broccoli). Prevents salt deposition, normalizes the lipid spectrum of cholesterol, enriches the body with vitamins K and C.
• Asparagus . Helps lower blood pressure and reduce cholesterol in the blood.
• Persimmon . Rich in fiber and has a pronounced antioxidant effect.
• Spinach . Allows you to reduce blood pressure in hypertensive patients.
• Turmeric . It has an anti-atherosclerotic effect, reduces the volume of cholesterol plaques, and reduces the severity of the inflammatory process.

List of sources

• Matyushenko A.A. “Pulmonary embolism as a general medical problem”, article in the journal RMZh No. 13 dated 07/03/1999
• Atayan A.A., Kosenkov A.N., Kuznetsov M.R., Chernookov A.I., Ivanova M.I., Khachatryan E.O. “Hybrid tactics in the treatment of acute disorders of mesenteric circulation”, RMZh No. 8(II) dated 10.25.2019
• Yavelov I.S. “The use of anticoagulants during thrombolytic therapy in patients with signs of acute occlusion of the coronary artery: how to individualize treatment?”, RMZh No. 26 of November 30, 2011

Signs

Distal occlusion pathology is identified before a dental examination based on the patient’s facial shape. The lower part of the face is shortened, and the upper jaw protrudes or is smoothed, depending on the form of the pathology. The mouth is usually slightly open, and the lower lip is located behind the upper incisors; there is a specific fold on the chin. Teeth are crowded and incorrectly aligned.

Distal bite photo.

Patients complain of difficulty biting and chewing food. Their incisors and premolars do not completely close. If the anomaly is severe, there may be problems with sound pronunciation and breathing.