Almost amputated because of mistaken belief
Patient HMY (54 years old, in Van Chan district, Yen Bai province) had had some leg pain before, but partly thought that the disease was old age bone and joint pain, part of her family was difficult, so she was afraid to go. examination.
Eight days ago, he suddenly felt a lot of pain in the thigh area and began to spread to the right leg and accompanied by cold feet, difficult to move. Mr. Y shared: “My right leg is constantly increasing in pain, cold, numb and has decreased sensation in my feet. I can’t walk, I keep raising my leg to relieve the pain”.
The patient was taken to Yen Bai Provincial General Hospital by family members for treatment. Here, the doctors determined that this was a severe acute limb artery occlusion with the risk of necrosis requiring amputation. The patient was immediately transferred to the Cardiovascular Center, E.
Because the family is too poor, doctors at Yen Bai Provincial General Hospital together contribute to support the patient’s ambulance trip to Hanoi.
At the time of admission to the emergency room at the Cardiovascular Center, Hospital E, the patient’s right leg was in a state of swelling and cold purple in the shins and feet with mild symptoms of calves, pressing pain. , reduced movement and sensation. The doctors examined and found that there was no pulse from the upper thigh to the popliteal and dorsal foot, and there were some spots of ischemic black necrosis in the right dorsal part.
Film image of the patient.
Doctors appoint doppler ultrasound, computed tomography angiography and other laboratory tests to find the cause of the patient’s embolism. After getting the results, the doctors concluded that Mr. Y had acute leg ischemia due to complete occlusion of the arteries of the femoral, popliteal and right leg due to atherosclerosis and hypercoagulable state forming thrombus. . The patient was indicated for emergency surgery.
MSc Doan Van Nghia, The Department of Cardiovascular and Thoracic Surgery – Cardiovascular Center, Hospital E – a participant in the operation, said that the first surgery lasted about 1 hour. After dissecting the artery and opening it, assessing the condition of the atherosclerotic vessel, thickening it, and filling the lumen, the surgical team used a specialized catheter to remove a lot of old and new thrombus. from the femoral artery to the leg is the cause of the patient’s limb ischemia.
After surgery, the patient still had a lot of pain in the lower leg and when the angiogram was rechecked, the blood vessel in the right leg from the artery, the pelvis to the femoral artery was recanalized. But the popliteal artery down the instep is still blocked by the thrombus. The doctors decided to operate again to remove the thrombus to avoid the risk of having to amputate the patient’s limb later.
To be more careful for the patient, the doctors of the Department of Cardiovascular and Thoracic Surgery conducted a consultation with the doctors of the Department of Allergy, Immunology and Dermatology to determine that the patient had antiphospholipid syndrome causing the condition. Antibody-mediated hypercoagulability is characterized by recurrent arterial or venous thrombosis in the presence of antiphospholipid antibodies.
This is an autoimmune disease that occurs when the body’s immune system mistakenly creates antibodies against its own healthy cells and produces antibodies that cause the blood to clot. This disease causes dangerous complications such as kidney failure, stroke, pregnancy complications (for women). Particularly for the heart, blood clots can block all blood vessels in the body including arteries and veins, and damage the heart.
“The patient admitted to the hospital had atherosclerotic disease accompanied by a dangerous autoimmune disease, so during the dissection, the blood vessels were exposed. In this case, the surgeons needed to have professional qualifications. proficiency and ingenuity to conduct all old and new thrombi, reducing the risk of complications in order to completely revascularize the patient” – MSc.BS Nghia shared.
According to doctors, acute limb artery occlusion occurs due to the sudden blockage of the artery lumen by a blood clot or an atherosclerotic plaque, foreign body… The consequences of this lack of blood supply are not promptly resolved. then the limb will be necrotic within a few hours to a few days, even severe can lead to death.
In fact, the initial symptoms of acute limb artery occlusion are easily confused with other diseases such as osteoarthritis, disc herniation, etc., so patients are often subjective, omit or delay going to the doctor.
Common symptoms of acute limb artery occlusion are pain (sudden, severe onset in the occluded limb); paresthesias (feeling of numbness, tingling in the skin of the extremities with occlusion, worse, loss of sensation); Cold extremities and pale, some severe cases may purple limbs. In addition, there are symptoms such as loss of pulse in the extremities below the occlusion; Finger movements will be weak, even completely paralyzed…
Those at risk of acute limb artery occlusion are those with pre-existing cardiovascular disease such as atrial fibrillation, mitral stenosis, infective endocarditis, left atrial mucinous tumor, aneurysm, and atherosclerosis. , vasculitis, etc. or people with hypercoagulable diseases such as polycythemia vera, thrombocytosis, cancer, diabetes, hyperlipidemia, cigarette smoking and age 50 and older.
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