Acute Vascular Occlusion
The most common reason is that clots formed on damaged heart valves break off and block the vein in a certain area. In this case, circulation is disturbed below the area where the occluded vein is. Very severe pain, cooling of the standing leg, discoloration (bruising) occur within hours. This situation requires emergency surgical intervention in the first 4-6. With the operation, the clot inside the vein is cleaned with the help of a special catheter. If this intervention is delayed, irreversible damage to the tissues may occur. After the surgery, research is made for the cause of acute vascular occlusion and the treatment of the patient is continued accordingly.
Atherosclerosis, popularly known as arteriosclerosis, is the most important cause of chronic (slowly developing) vascular occlusions. High serum cholesterol levels, hypertension, diabetes, smoking, and genetic factors are among the causes of atherosclerosis. As a result of atherosclerosis, a plaque forms on the vessel wall. And over time, it grows and begins to block blood flow. Clinical symptoms differ according to the degree of blood flow obstruction.
In mild congestion, symptoms such as pain, numbness, and weakness occur in the leg after walking for a long time. As the degree of congestion increases, pain occurs with walking fewer distances.
In the advanced stages of the disease, pain occurs while resting. Wounds begin to occur in the tissues that cannot be fed and whose blood supply is impaired.
Early stages of the disease require surgical treatment, while drug therapies that will control atherosclerosis and support the peripheral circulation are given. Generally applied surgeries are by-pass surgeries in the form of placement of artificial vein grafts that will allow blood to be carried to the area below the occluded vessel.
Another common form of chronic artery occlusions is Buerger’s disease. It is a disease that involves the small arteries in the legs and mostly together with the small veins and nerve sheaths in young male patients who are mostly smokers. There are symptoms such as leg pain with walking, cold sensitivity in the leg, and recurrent attacks of superficial vascular inflammation. In the following periods, severe pain wound formations called ulcers and gangrene are frequently observed. By quitting smoking in the early period, aggravation of the disease can be prevented to a great extent. However, it often requires surgical intervention.
Raynaud’s disease is a disease that affects the veins in the fingers and toes, nose, and ears. It progresses with attacks that occur with sudden narrowing of the vessels in the aforementioned regions. It can be a single disease or accompany other diseases, in this case, it is called “Raynaud’s syndrome”. Raynaud’s syndrome most often occurs with connective tissue diseases. These diseases cause thickening of the vessel wall and cause the vessels to contract very quickly. Arterial disorders, some blood pressure, and migraine medications can cause Raynaud’s syndrome.
Its incidence in the community is between 5-10% and it occurs mostly in women between the ages of 15-40. Its incidence increases in places with cold climates. Attacks in patients usually occur with exposure to cold and sometimes with stress. Usually, fingers and toes are affected. However, sometimes symptoms occur in the nose, lips, and ears.
Normally, when faced with cold, the body tries to reduce heat loss in order to maintain its temperature. For this, the veins on the surface are contracted. This response is very sudden and severe in those with Raynaud’s disease. And as a result, blood flow to the extremities of the body, the hands, and feet, is severely reduced.
When the attack starts, the fingers and toes first turn white, then bruising and redness. However, color change in this classical sequence may not occur in all patients. Whitening is due to the sudden closure of the small arteries in the fingers and the inability of oxygen-rich blood to reach the tissues because the blood vessels are closed. Meanwhile, numbness in the fingers may occur. When the veins open and the blood flow improves, the color turns red. After the attack, there may be a tingling sensation in the fingers. The attacks can range in length from a few minutes to several hours. Since tissue nutrition is impaired with recurrent attacks, ulcers and gangrene may occur on the skin on the fingertips.
The aim of the treatment is to reduce the frequency and severity of attacks and thus prevent permanent tissue damage. The frequency and severity of attacks can be reduced with some simple precautions. The most important point is to be protected from the cold. It is necessary to protect not only the hands and feet but also the whole body from cold. In addition to gloves and socks, hats are also important, as body heat is largely lost from the scalp.
These patients should avoid smoking. Because nicotine can trigger attacks. It may be helpful to seek professional help with stress management.
Calcium channel blockers are the most reliable drug therapy. They expand the vessels by allowing the smooth muscles in the vessel wall to relax.
Alpha-blockers, which have an opposite effect on the activity of the norepinephrine hormone, which causes narrowing of the vessels, are another drug group used in the treatment. Other drug groups can be tried in the treatment of vasodilating drugs. Surgical methods can be applied to prevent sympathetic nerve activity that causes narrowing of the vessels in severe patients with fingertip wounds. (Sympathetic nerve blockage or sympathectomy) While primary Raynaud’s disease responds better to treatment, Raynaud’s syndrome is more difficult to treat.