Arterial thrombosis can have many different faces and affect the heart, brain or extremities, causing completely different symptoms, even though the cause is the same. Thrombosis is always a very serious condition that can even be life threatening. Find out what exactly arterial thrombosis is. What are the symptoms and causes of thrombosis?

Arterial thrombosisis the abnormal clotting of blood in the arteries, usually the result of atherosclerotic plaques. The effects of this process can be very diverse: heart attack, stroke, limb or intestinal ischemia. These are life-threatening conditions requiring immediate medical intervention.

Management depends largely on the general condition of the patient, the severity of ischemia and the time in which the process progressed. In addition to anticoagulant treatment to inhibit disease progression, possible therapeutic options are: local fibrinolytic treatment, surgical treatment or minimally invasive treatment. Then it is necessary to treat the causes of thrombosis and long-term therapy to prevent relapse.

Thrombosis and embolism

The term "thrombosis" should not be confused with the phenomenon of embolism, despite similar effects, the mechanism is completely different.

An embolism occurs when, as a result of the clot breaking off, it travels with the bloodstream and causes ischemia in a place distant from its formation. An embolism may be caused not only by a blood clot, but also by a foreign body, adipose tissue or a torn atherosclerotic plaque.

Thrombosis, in turn, is the process of the formation of blood clots (thrombi), i.e. conglomerates of blood cells and plasma coagulation factors in the vessels. This phenomenon occurs when three conditions are met: the vessel wall changes, the vessel wall is damaged, the layered blood flow is disturbed, and the blood composition changes.

Unlike embolism, thrombosis causes ischemia at the site of origin, which is of great practical importance.

Treatment of these two phenomena is different - embolism most often results from blood coagulation and should be treated systemically, while thrombosis results from local causes and the therapy is most often performed at the site of its origin.

Thrombosis occurs more often in the veins, causing venous thromboembolism, or pulmonary embolism. This phenomenon is less common in the arteries, but can have very serious consequences. Formation of a clot initially reduces the flow in the vessel, and when it covers the entire lumen of the vessel, it completely blocks the blood supply to the periphery, causing ischemia.

Arterial thrombosis - causes

How does arterial thrombosis happen? In the vast majority of cases, atherosclerosis is to blame. If the atherosclerotic plaques grow rapidly, they can become so-called unstable plaques, which may predispose them to rupture.

If this happens, the content of the plaque is released, the vessel layer is damaged, but there is no bleeding. Despite this, the body interprets this as a vessel damage and blood clotting in this area begins.

Cracked plaque constantly secretes factors that promote clotting, the process is constantly going on, ultimately it is the increased clotting that causes the formation of a conglomerate of blood cells and coagulation factors that close the entire lumen of the vessel.

Other situations leading to arterial thrombosis include:

  • blockages, i.e. fragments of material traveling downstream of the blood, closing the blood vessels, in such cases thrombosis develops behind the embolic material, because there are disturbances in blood flow and damage to the vessel wall
  • vessel injuries: rupture, contusion; in this case, the course of events is similar to that in atherosclerosis: damage to the vessel wall activates coagulation and, if the process is not inhibited, closes the entire vessel
  • inflammatory vascular diseases that contribute to a change in the flow in the vessel and negatively affect the condition of the walls
  • diseases caused by blood coagulation, e.g. antiphospholipid syndrome, polycythemia or hyperthaemia, due to changes in blood composition, the risk of pathological clotting increases significantly, sometimes leading to thrombosis
  • use of certain drugs and stimulants
  • aneurysms - these abnormalities in the structure of the vessel wall carry a risk associated not only with bursting and severe hemorrhages, but also create an environment for the formation of blood clots in their lumen, leading to obstruction

Arterial thrombosis - effects

Blood clots in the arteries can cause serious complications:

  • ischemic stroke - it may occur as a result of damage to the plaque of the intracerebral arteries
  • heart attack - whenthe coronary arteries are closed by blood clots forming on atherosclerotic plaques
  • acute ischemia of the lower limbs as a result of blood clots formed on the basis of atherosclerotic plaque in the abdominal aorta and large arteries
  • acute intestinal ischemia in case of mesenteric artery occlusion

All these states and their consequences pose a direct threat to life.

Acute limb ischemia also carries the risk of other complications: the real possibility of loss of this limb and damage to the kidneys, and intestinal ischemia: perforation and peritonitis.

All these complications result, on the one hand, from the impairment of essential organs (brain and heart), and from the large amount of toxins released by the ischemic organ within which necrosis (limbs) occurs.

Arterial thrombosis - symptoms

Symptoms of thrombosis are very diverse and depend on the place of its formation - not only the body area and organ, but also the size of the artery, the quality of the vascularization and the time the clot grows.

It is obvious that the most dangerous is thrombosis located in the central nervous system and the heart, moreover, the larger the vessel the pathology affects, the more serious the condition causes, because a larger area of ​​the body is ischemic.

Collateral circulation, in turn, may be a rescue for people suffering from thrombosis. Under certain conditions, additional arteries are created to supply a specific area of ​​the body from other sources.

This most often happens during prolonged ischemia. In this case, if the main vessel is closed and the collateral circulation is profusely developed, the thrombosis may be much milder or even asymptomatic.

The exact symptoms of occlusion of arteries with blood clots are:

  • ischemic stroke manifested by sudden paresis - weakening of muscle strength, dropping the corner of the mouth or visual disturbance
  • heart attack causing typically: severe distressing pain in the chest radiating to the face and left hand
  • acute ischemia of the lower limbs when the arteries that supply them are closed; they cause severe pain, cooling down and paling of the limb with no perceptible pulse, followed by disturbances in sensation and mobility; if the help is not provided on time, limb necrosis may occur
  • acute intestinal ischemia in the case of occlusion of the mesenteric artery is manifested by: abdominal pain, diarrhea, sometimes with blood, these symptoms are very nonspecific and in their case it is difficult to estimate only on their basisrecognition
  • acute renal ischemia as a result of renal artery thrombosis, resulting in renal artery damage and renal failure

Arterial thrombosis - diagnosis

Each of the effects of thrombosis is diagnosed differently, but each requires urgent diagnosis and treatment. The reported symptoms and the results of the medical examination guide the correct diagnosis, the choice of further tests is based on the suspected cause:

  • ischemic stroke: here the basis of diagnosis is computed tomography of the head, much less often magnetic resonance imaging
  • a heart attack is diagnosed with the help of an ECG, laboratory tests - troponins and creatine kinase, and finally in coronary angiography, i.e. an invasive examination of the coronary arteries
  • if acute lower limb ischemia is suspected, Doppler ultrasound is performed, i.e. vascular flow assessment, arteriography, i.e. vascular evaluation after administration of contrast agent and X-ray examination, and computed tomography with contrast to assess the arteries of the lower extremities and the place of possible closure
  • acute ischemia of the intestines and kidneys, as well as ischemia of the limbs, is diagnosed by computed tomography with contrast

The methods described above are specific to the diseases mentioned above, apart from them, more detailed diagnostics are often performed, such as laboratory tests or echo of the heart in the event of a heart attack.

Arterial thrombosis: treatment

Treatment of arterial thrombosis begins with the administration of drugs that inhibit blood clotting and painkillers, and the initial stabilization of the patient's condition. What you do next depends on where the clot has formed.

Thrombotic arteries can be restored mechanically or pharmacologically, the treatment used depends on where the clot has formed and what is the best method for the patient at the moment. thrombolysis - treatment which consists of administering a drug that dissolves the blood clot. It can be administered systemically - intravenously or to the site of a blood clot.

A heart attack is treated by performing coronary angioplasty - ballooning and stenting. If there is no possibility of quick surgical treatment, fibrinolysis can be used.

Acute limb ischemia can be treated with the mentioned fibrinolysis. Unfortunately, due to the risk of complications and the severity of symptoms, such treatment is not always possible, as its use may lead to dangerousinternal bleeding, including bleeding into the brain.

Moreover, the administration of fibrinolysis makes it much more difficult, and sometimes even impossible, to perform the surgery due to heavy bleeding. Another option is surgery and mechanical removal of the thrombus, in which case fibrinolytic treatment is delayed or abandoned altogether.

If there is a threat of limb loss, it is necessary to urgently open the vessel, which unfortunately may be ineffective, then amputation is necessary.

Acute intestinal ischemia, like limb ischemia, can be treated surgically or by administering fibrinolysis.

In most cases, immediate action is required. Treatment depends on the presence of other diseases, your general condition, and how long your ischemia lasts.

Long-term management is based on identifying the cause of the embolism and treating it, as well as appropriate therapy after the procedures, e.g. antiplatelet treatment after coronary angioplasty.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

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Cardiology