What is damage to the main blood vessels. Great vessels and their major branches Causes of transposition of the great vessels

In them, rhythmically pulsating blood flow turns into a uniform, smooth one. The walls of these vessels have few smooth muscle elements and many elastic fibers.

Resistive vessels(resistance vessels) include precapillary (small arteries, arterioles) and postcapillary (venules and small veins) resistance vessels.

capillaries(exchange vessels) - the most important department of the cardiovascular system. They have the largest total cross-sectional area. Through the thin walls of the capillaries there is an exchange between blood and tissues (transcapillary exchange). The walls of the capillaries do not contain smooth muscle elements.

Capacitive vessels - venous part of the cardiovascular system. They contain approximately 60-80% of the volume of all blood (Fig. 7.9).

Shunt vessels- arteriovenous anastomoses, which provide a direct connection between small arteries and veins, bypassing the capillaries.

Patterns of the movement of blood vessels

The movement of blood is characterized by two forces: the difference in pressure at the beginning and at the end of the vessel and the hydraulic resistance that prevents the flow of fluid. The ratio of the pressure difference to the counteraction characterizes the volumetric flow rate of the liquid. The volumetric flow rate of the liquid - the volume of liquid that flows through the pipe per unit time - is expressed by the equation:

Rice. 7.9. Proportion of blood volume in different types of vessels

where: Q is the volume of liquid;

pressure difference between the beginning and the end of a vessel through which a liquid flows

R is flow resistance (resistance).

This dependence is the main hydrodynamic law: the greater the amount of blood flowing per unit time through the circulatory system, the greater the pressure difference in its arterial and venous ends and the less resistance to blood flow. The basic hydrodynamic law characterizes the state of blood circulation in general and blood flow through the vessels of individual organs. The amount of blood passing through the vessels of the systemic circulation in 1 min depends on the difference in blood pressure in the aorta and vena cava and on the total resistance to blood flow. The amount of blood flowing through the vessels of the pulmonary circulation is characterized by the difference in blood pressure in the pulmonary trunk and veins and the resistance of blood flow in the vessels of the lungs.

During systole, the heart ejects 70 ml of blood into the vessels at rest (systolic volume). The blood in the blood vessels does not flow intermittently, but continuously. Blood is moved by vessels during relaxation of the ventricles due to potential energy. The human heart creates enough pressure to send blood spurting seven and a half meters forward. The stroke volume of the heart stretches the elastic and muscular elements of the wall of the great vessels. In the walls of the main vessels, a store of heart energy is accumulated, spent on their stretching. During diastole, the elastic wall of the arteries collapses and the potential energy of the heart accumulated in it moves the blood. Stretching of large arteries is facilitated due to the high resistance of resistive vessels. The importance of elastic vascular walls lies in the fact that they ensure the transition of intermittent, pulsating (as a result of contraction of the ventricles) blood flow into a constant one. This property of the vascular wall smooths out sharp fluctuations in pressure.

A feature of the myocardial blood supply is that the maximum blood flow occurs during diastole, the minimum - during systole. The capillary network of the myocardium is so dense that the number of capillaries is approximately equal to the number of cardiomyocytes!

Diseases of the main vessels and their prevention

The main arterial vessels are those large branches that pave the main paths for the movement of blood to various regions of the human body. All of them originate from the aorta emerging from the left ventricle of the heart. The main vessels include the vessels of the arms and legs, the carotid arteries that supply the brain with blood, the vessels that go to the lungs, kidneys, liver and other organs.

The most common diseases - obliterating endarteritis, atherosclerotic occlusion and thromboangiitis - most often affect the vessels of the legs. True, the vessels of internal organs and hands are often involved in the process.

So, for example, there is damage to the vessels of the eyes, which is accompanied by changes in the retina, eyeball, conjunctiva. Or the disease process affects the vessel of the mesentery of the small intestine, and then there is a sharp spasm of the intestine, which leads to severe pain in the abdomen. But still, the vessels of the lower extremities are more often affected in patients. These patients complain of pain in the calves, often forcing the patient to stop for a while (intermittent claudication).

Scientists have always been interested in the causes and mechanisms of development of these diseases. The famous Russian surgeon Vladimir Andreevich Oppel, even during the First World War, believed that vasospasm occurs as a result of an increase in the function of the adrenal glands. An increase in the function of the adrenal medulla leads to an increase in the amount of adrenaline, which causes vasospasm. Therefore, he removed one of the adrenal glands from those suffering from endarteritis (there are only two of them) and the patients felt better for a while after the operation. However, after 6-8 months, the spastic process resumed with renewed vigor and the disease continued to progress.

J. Diez, and then the famous French surgeon Rene Lerish put forward the point of view that the development of obliterating endarteritis is based on dysfunction of the sympathetic nervous system. Therefore, the first suggested removing the sympathetic lumbar nodes, and the second recommended performing periarterial sympathectomy, that is, freeing the main arteries from sympathetic fibers. A break in vessel inversion, according to Leriche, led to the elimination of spasm and an improvement in the condition of patients. However, after some time, the vascular process resumed, the disease continued to progress. Consequently, the methods of treatment proposed by scientists were ineffective.

The experience of the Great Patriotic War of 1941-1945 made it possible to put forward new views on the etiology and pathogenesis of the disease, which boil down to the following provisions. Firstly, excessive tension of the central nervous system in a combat situation led to a decrease in the adaptive-trophic function of the sympathetic nervous system and a breakdown in the relationship between adaptation systems; secondly, various harmful influences (frostbite, smoking, negative emotions) had an adverse effect on the capillary network of the lower parts of the arms and legs, and, above all, the feet and hands. As a result, the number of patients with obliterating endarteritis in the post-war years increased by 5-8 times compared to the pre-war years.

In addition to spasm, a significant role in the development of the disease is played by changes that occur under the influence of these factors in the connective tissue of the vascular wall. Connective tissue fibers in this case grow and lead to obliteration (desolation) of the lumen of small arteries and capillaries. As a result of such changes, a sharp disproportion occurs between the need for oxygen in tissues and their provision. The tissues, figuratively speaking, begin to "suffocate" from oxygen deficiency.

As a result, the patient experiences severe pain in the affected limbs. Violation of tissue nutrition leads to the appearance of skin cracks and ulcers, and with the progression of the disease process, to necrosis of the peripheral part of the limb.

Transposition of the great vessels is a congenital heart defect, one of the most severe and, unfortunately, the most common. According to statistics, it is 12-20% of congenital disorders. The only way to treat the disease is surgery.

The cause of the pathology has not been established.

Normal heart function

The human heart has two ventricles and two atria. Between the ventricle and the atrium there is an opening closed by a valve. Between the two halves of the organ is a solid partition.

The heart works cyclically, each such cycle includes three phases. In the first phase - atrial systole, blood is transferred to the ventricles. In the second phase - ventricular systole, blood is supplied to the aorta and pulmonary artery, when the pressure in the chambers becomes higher than in the vessels. In the third phase, there is a general pause.

The right and left parts of the heart serve the small and large circles of blood circulation, respectively. From the right ventricle, blood is supplied to the pulmonary arterial vessel, moves to the lungs, and then, enriched with oxygen, returns to the left atrium. From here, it is passed to the left ventricle, which pushes oxygen-rich blood into the aorta.

The two circles of blood circulation are connected to each other only through the heart. However, the disease changes the picture.

TMS: description

In transposition, the main blood vessels are reversed. The pulmonary artery moves blood to the lungs, the blood is saturated with oxygen, but enters the right atrium. The aorta from the left ventricle carries blood throughout the body, but the vein returns the blood to the left atrium, from where it is transferred to the left ventricle. As a result, the circulation of the lungs and the rest of the body are completely isolated from each other.

Obviously, this condition is a threat to life.

In the fetus, the blood vessels serving the lungs are not functioning. In a large circle, blood moves through the ductus arteriosus. Therefore, TMS does not pose an immediate threat to the fetus. But after birth, the situation of children with this pathology becomes critical.

The life expectancy of children with TMS is determined by the existence and size of the opening between the ventricles or atria. This is not enough for normal life, which causes the body to attempt to compensate for the condition by increasing the volume of pumped blood. But such a load quickly leads to heart failure.

The condition of the child may even be satisfactory in the early days. A clear external sign in newborns is only a distinct cyanosis of the skin - cyanosis. Then shortness of breath develops, there is an increase in the heart, liver, and edema appears.

X-rays show changes in the tissues of the lungs and heart. Descent of the aorta can be seen on angiography.

Disease classification

The disease is of three main types. The most severe form is simple TMS, in which vascular transposition is not compensated by additional heart defects.

Simple TMS - complete swapping of the main vessels, the small and large circles are completely isolated. The child is born full-term and normal, since during the intrauterine development of the fetus, the mixing of blood was carried out through the open ductus arteriosus. After the birth of children, this duct closes, as it is no longer needed.

With simple TMS, the duct remains the only way to mix venous and arterial blood. A number of preparations have been developed that keep the duct open to stabilize the position of a small patient.

In this case, urgent surgical intervention is the only chance for survival for the child.

Transposition of vessels with defects in the interventricular or atrial septum - an abnormal hole in the septum is added to the pathology. Through it, a partial mixing of blood occurs, that is, a small and a large circle still interact.

Unfortunately, such a kind of compensation does not give anything good.

Its only plus is that the position of children after birth remains stable for several weeks, not days, which allows you to accurately identify the picture of the pathology and develop an operation.

The size of a septal defect can vary. With a small diameter, the symptoms of the defect are somewhat smoothed out, but they are observed and allow you to quickly establish a diagnosis. But if the exchange of blood occurs in sufficient quantities for the child, then his condition seems to be quite safe.

Unfortunately, this is not the case at all: the pressure in the ventricles equalizes due to the communicating hole, which causes pulmonary hypertension. Lesions of the vessels of the small circle in children develop too quickly, and when they are in a critical condition, the child becomes inoperable.

Corrected transposition of the great vessels - there is a change in the location of not the arteries, but the ventricles: depleted venous blood is in the left ventricle, to which the pulmonary artery adjoins. Oxygenated blood is transferred to the right ventricle, from where it moves through the aorta into a large circle. That is, blood circulation, although according to an atypical pattern, is carried out. It does not affect the condition of the fetus and the child born.

This condition is not a direct threat. But children with pathology usually show some developmental delay, since the right ventricle is not designed to serve a large circle and its functionality is lower than that of the left one.

Identification of pathology

The disease is detected in the early stages of fetal development, for example, using ultrasound. Due to the peculiarities of the fetal blood supply, the disease before birth practically does not affect development and does not manifest itself in any way. This asymptomaticity is the main reason for not detecting a defect until the birth of children.

The following methods are used to diagnose newborns:

• ECG - with its help evaluate the electrical potential of the myocardium;
• echocardia - acts as the main diagnostic method, as it provides the most complete information about the pathologies of the heart and main vessels;
• radiography - allows you to determine the size of the heart and the placement of the pulmonary trunk, with TMS they differ markedly from normal;
• catheterization - makes it possible to assess the operation of valves and pressure in the heart chambers;
• angiography is the most accurate method for determining the position of blood vessels;
• CT heart. PET - are prescribed to identify comorbidities for the development of optimal surgical intervention.

When a pathology is detected in the fetus, the question of terminating the pregnancy almost always arises. There are no other methods other than surgery, and operations of this level are performed only in specialized clinics. Ordinary hospitals can only offer Rashkind's operation. This allows you to temporarily stabilize the condition of children with heart disease, but is not a cure.

If the pathology is found in the fetus, and the mother insists on bearing, first of all, you need to take care of the transfer to a specialized maternity hospital, where it will be possible immediately, immediately after birth, to carry out the necessary diagnostics.

TMS treatment

The disease is cured only by surgery. The best time, according to surgeons, is in the first two weeks of life. The more time passes between birth and surgery, the more disrupted the work of the heart, blood vessels and lungs.

Operations for all types of TMS have been developed for a long time and are being successfully carried out.

• Palliative - a number of operational measures are carried out in order to improve the functioning of the small circle. An artificial tunnel is created between the atria. At the same time, the right ventricle sends blood both to the lungs and to a large circle.
• Corrective - completely eliminate the violation and related anomalies: the pulmonary artery is sutured to the right ventricle, and the aorta to the left.

Patients with TMS should be under the constant supervision of a cardiologist even after the most successful operation. As children grow, complications may arise. Some restrictions, such as a ban on physical activity, must be observed throughout life.

Transposition of the great vessels is a severe and life-threatening heart disease. At the slightest doubt in the condition of the fetus, it is worth insisting on a thorough examination using ultrasound. No less attention should be paid to the condition of the newborn, especially if cyanosis is observed. Only timely surgical intervention is a guarantee of a child's life.

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Transposition of the great vessels

Transposition of the great vessels is a severe congenital pathology of the heart, characterized by a violation of the position of the main vessels: the aorta originates from the right heart, and the pulmonary artery from the left. Clinical signs of transposition of the great vessels include cyanosis, dyspnea, tachycardia, malnutrition, and heart failure. Diagnosis of transposition of the great vessels is based on the data of FCG, ECG, X-ray examination of the chest organs, catheterization of the heart cavities, ventriculography. Palliative interventions (balloon atrioseptostomy) and radical operations (Mastard, Senning, Zhatenet, Rastelli, arterial switching) serve as methods for the operational correction of the transposition of the great vessels.

Transposition of the great vessels

Transposition of the great vessels is a congenital heart disease, the anatomical basis of which is the incorrect location of the aorta and pulmonary artery relative to each other and their reverse discharge from the ventricles of the heart. Among the various CHDs, transposition of the great vessels is 7–15%; 3 times more common in boys. Transposition of the great vessels is one of the "big five" - ​​the most common congenital anomalies of the heart, along with ventricular septal defect, coarctation of the aorta, patent ductus arteriosus, tetralogy of Fallot.

In cardiology, transposition of the great vessels refers to critical blue-type heart defects that are incompatible with life, and therefore require surgical intervention in the first weeks of life.

Causes of transposition of the great vessels

Anomalies in the development of the great vessels are formed in the first 2 months of embryogenesis as a result of chromosomal aberrations, unfavorable heredity, or negative external influences. Exogenous factors can be viral infections suffered by a pregnant woman (SARS, rubella, chicken pox, measles, mumps, herpes, syphilis), toxicosis, radiation exposure, drugs, alcohol intoxication, polyhypovitaminosis, maternal diseases (diabetes mellitus), age-related changes in the body of a woman over 35 years old. Transposition of the great vessels occurs in children with Down syndrome.

The direct mechanisms of transposition of the great vessels are not fully understood. According to one version, the defect is caused by an incorrect bending of the aortic-pulmonary septum during cardiogenesis. According to more modern ideas, the transposition of the great vessels is the result of abnormal growth of the subaortic and subpulmonary cone when the arterial trunk bifurcates. During normal heart formation, resorption of the infundibular septum leads to the formation of an aortic valve posteriorly and inferiorly from the pulmonic valve, above the left ventricle. When the great vessels are transposed, the resorption process is disturbed, which is accompanied by the location of the aortic valve above the right ventricle, and the pulmonary valve - above the left.

Classification of transposition of the great vessels

Depending on the number of accompanying communications that perform a compensatory role, and the state of the pulmonary circulation, the following variants of transposition of the great vessels are distinguished:

1. Transposition of the great vessels, accompanied by hypervolemia or normal pulmonary blood flow:

2. Transposition of the great vessels, accompanied by a decrease in pulmonary blood flow:

• with stenosis of the outflow tract of the left ventricle
• with VSD and stenosis of the outflow tract of the left ventricle (complex transposition)

In 80% of cases, the transposition of the great vessels is combined with one or more additional communications; in 85-90% of patients, the defect is accompanied by hypervolemia of the pulmonary circulation. The transposition of the great vessels is characterized by a parallel arrangement of the aorta relative to the pulmonary trunk, while in a normal heart both arteries cross. Most often, the aorta is located in front of the pulmonary trunk, in rare cases, the vessels are located in the same plane in parallel, or the aorta is localized posterior to the pulmonary trunk. In 60% of cases, D-transposition is found - the position of the aorta to the right of the pulmonary trunk, in 40% - L-transposition - the left-sided position of the aorta.

Features of hemodynamics in transposition of the great vessels

From the standpoint of assessing hemodynamics, it is important to distinguish between complete transposition of the great vessels and corrected one. With corrected transposition of the aorta and pulmonary artery, there is ventricular-arterial and atrioventricular discordance. In other words, the corrected transposition of the great vessels is combined with ventricular inversion, so intracardiac hemodynamics is carried out in a physiological direction: arterial blood enters the aorta, and venous blood enters the pulmonary artery. The nature and severity of hemodynamic disorders in corrected transposition of the great vessels depend on concomitant defects - VSD, mitral insufficiency, etc.

The full form combines discordant ventricular-arterial relationships with a concordant relationship of other parts of the heart. With complete transposition of the great vessels, venous blood from the right ventricle enters the aorta, spreads through the systemic circulation, and then again enters the right heart. Arterial blood is ejected by the left ventricle into the pulmonary artery, through it into the pulmonary circulation and again returns to the left heart.

In the intrauterine period, the transposition of the great vessels practically does not disturb the fetal circulation, since the pulmonary circle in the fetus does not function; blood circulation is carried out in a large circle through an open oval window or open ductus arteriosus. After birth, the life of a child with complete transposition of the great vessels depends on the presence of concomitant communications between the pulmonary and systemic circulation (OOO, VSD, PDA, bronchial vessels), which ensure the mixing of venous blood with arterial blood. In the absence of additional defects, children die immediately after birth.

When the great vessels are transposed, blood shunting is carried out in both directions: in this case, the larger the size of the communication, the less the degree of hypoxemia. The most favorable are cases when ASD or VSD provide sufficient mixing of arterial and venous blood, and the presence of moderate pulmonary artery stenosis prevents excessive hypervolemia of the small circle.

Symptoms of transposition of the great vessels

Children with transposition of the great vessels are born full-term, with normal or slightly increased weight. Immediately after birth, with the beginning of the functioning of a separate pulmonary circulation, hypoxemia increases, which is clinically manifested by total cyanosis, shortness of breath, and tachycardia. With transposition of the great vessels, combined with PDA and coarctation of the aorta, differentiated cyanosis is revealed: the cyanosis of the upper half of the body is more pronounced than the lower.

Already in the first months of life, signs of heart failure develop and progress: cardiomegaly, an increase in the size of the liver, less often - ascites and peripheral edema. When examining a child with transposition of the great vessels, attention is drawn to the deformity of the phalanges of the fingers, the presence of a heart hump, malnutrition, and a lag in motor development. In the absence of pulmonary artery stenosis, blood overflow of the pulmonary circulation leads to the frequent occurrence of recurrent pneumonia.

The clinical course of corrected transposition of the great vessels without concomitant CHD is asymptomatic for a long time, there are no complaints, the child develops normally. When contacting a cardiologist, paroxysmal tachycardia, atrioventricular blockade, and heart murmurs are usually detected. In the presence of concomitant CHD, the clinical picture of corrected transposition of the great vessels depends on their nature and the degree of hemodynamic disturbances.

Diagnosis of transposition of the great vessels

The presence of a transposition of the great vessels in a child is usually recognized even in the maternity hospital. Physical examination reveals hyperactivity of the heart, a pronounced cardiac impulse, which is displaced medially, an expanded chest. Auscultatory findings are characterized by an increase in both tones, a systolic murmur, and a PDA or VSD murmur.

In children aged 1-1.5 months, ECG shows signs of overload and hypertrophy of the right heart. When evaluating chest x-ray, highly specific signs of transposition of the great vessels are: cardiomegaly, a characteristic configuration of the egg-shaped heart shadow, a narrow vascular bundle in the anteroposterior projection and expanded in the lateral projection, the left position of the aortic arch (in most cases), depletion of the lung pattern in pulmonary artery stenosis or its enrichment in septal defects.

Echocardiography shows abnormal origin of the great vessels, wall hypertrophy and dilatation of the heart chambers, concomitant defects, and the presence of pulmonary artery stenosis. With the help of pulse oximetry and a study of the gas composition of the blood, the parameters of blood oxygen saturation and the partial pressure of oxygen are determined: when the main vessels are transposed, SO2 is less than 30%, PaO2 is less than 20 mm Hg. When probing the cavities of the heart, an increased saturation of blood with oxygen in the right atrium and ventricle and a decreased one in the left parts of the heart are detected; equal pressure in the aorta and right ventricle.

X-ray contrast research methods (ventriculography, atriography, aortography, coronary angiography) visualize the pathological flow of contrast from the left heart into the pulmonary artery, and from the right into the aorta; concomitant defects, anomalies of the origin of the coronary arteries. Transposition of the great vessels should be distinguished from tetralogy of Fallot, pulmonary artery atresia, tricuspid valve atresia, hypoplasia of the left heart.

Treatment of transposition of the great vessels

All patients with complete transposition of the great vessels are indicated for emergency surgical treatment. Contraindications are cases of development of irreversible pulmonary hypertension. Before surgery, newborns are given prostaglandin E1 drug therapy, which helps keep the ductus arteriosus open and ensures adequate blood flow.

Palliative interventions for transposition of the great vessels are necessary in the first days of life to increase the size of a natural or create an artificial defect between the pulmonary and systemic circulation. Such operations include endovascular balloon atrial septostomy (Park-Rashkind operation) and open atrial septectomy (resection of the atrial septum according to Blalock-Hanlon).

Hemocorrective interventions performed during transposition of the great vessels include Mustard and Senning operations - intra-atrial switching of arterial and venous blood flows using a synthetic patch. At the same time, the topography of the main arteries remains the same, through the intra-atrial tunnel from the pulmonary veins, blood enters the right atrium, and from the vena cava - into the left.

Options for anatomical correction of transposition of the great vessels include various methods of arterial switching: Zhatenet operation (crossing and orthotopic replantation of the great vessels, ligation of the PDA), Rastelli operation (VSD repair and elimination of pulmonary artery stenosis), arterial switching with VSD plasty. Specific postoperative complications accompanying the correction of the transposition of the great vessels can be SSS, stenosis of the orifices of the pulmonary and caval veins, and stenosis of the outflow tracts of the ventricles.

Prognosis of transposition of the great vessels

Complete transposition of the great vessels is a critical heart disease incompatible with life. In the absence of specialized cardiac surgical care, half of the newborns die in the first month of life, more than 2/3 of children die by the age of 1 year from severe hypoxia, circulatory failure and increasing acidosis.

Surgical correction of simple transposition of the great vessels allows achieving good long-term results in 85–90% of cases; with a complex form of defect - in 67% of cases. After surgery, patients need to be monitored by a cardiac surgeon, limit physical activity, and prevent infective endocarditis. Prenatal detection of transposition of the great vessels using fetal echocardiography, appropriate management of pregnancy and preparation for childbirth are important.

Transposition of the great vessels - treatment in Moscow

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Main arteries of the head

Main arteries of the head

Rice. 1. Main arteries of the head and vessels of the base of the brain (scheme).

1 - anterior cerebral artery,

2 - anterior communicating artery,

3 - middle cerebral artery,

4 - ophthalmic artery,

5 - posterior communicating artery,

6 - posterior cerebral artery,

7 - superior artery of the cerebellum,

8 - main artery,

9 - anterior inferior cerebellar artery,

10 - internal carotid artery,

11 - vertebral artery,

12 - posterior inferior cerebellar artery,

13 - external carotid artery,

14 - common carotid artery,

15 - subclavian artery,

16 - shoulder-head trunk,

The internal carotid artery (a. carotis interna) is usually divided into an extracranial section, which includes 2 segments: a sinus and a cervical segment, and an intracranial section, which includes 3 segments: intraosseous, siphon and cerebral. C and n at with is a significantly expanded initial part of the internal carotid artery. It has a rich innervation (baro- and chemoreceptors) and plays an important role in the regulation of blood circulation. The cervical segment includes part of the artery from the sinus to the entrance to the skull. Both of these segments do not give branches. In the extracranial section, the internal carotid artery is exposed to a greater extent than in other sections to the effects of various damaging factors, such as mechanical trauma or compression from the outside.

What is atherosclerosis of the main arteries

Among diseases of the circulatory system, there is such as atherosclerosis of the main arteries of the head.

This problem is chronic and is a disruption of the blood vessels of the neck, head or limbs due to the occurrence of atherosclerotic plaques (otherwise lipid infiltrations).

They are localized on the walls of blood vessels, leading to the growth of connective tissue, and causing a narrowing of the lumen in the vessels and arteries. Because of this, there is insufficient blood circulation to the brain and limbs.

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Most often, atherosclerosis is observed in the main arteries of the lower extremities. Mostly men over the age of 40 are affected. As well as women in the period after the onset of menopause. The same can be said about atherosclerosis of the main arteries of the neck and head.

The reasons

Regardless of which main arteries are affected by lipid deposits and in which place atherosclerotic plaques have formed, the causes of this disease are the same:

• bad habits, mainly smoking;
• overweight;
• problems with the absorption of glucose into the blood;
• malnutrition;
• quite frequent stressful conditions;
• severely increased blood pressure that has not been treated for a long time;
• high cholesterol (several times higher than normal);
• diseases of the endocrine system;
• passive lifestyle;
• age-related changes in the body.

Branches of the main vessels of the brain

The mechanism of the course of pathology

The most important etiological factor of occlusion and stenosis (narrowing) of the main arteries in the head is atherosclerosis.

As a rule, atherosclerotic stenosis (narrowing) affects the cerebral arteries at the bifurcation of the carotid artery and at the beginning of the internal carotid artery.

In comparison with extracranial narrowing of the main arteries in the head, stenosis of the intracranial arteries of the brain is diagnosed 2-5 times less frequently.

If atherosclerosis of the main arteries of the neck and head develops strongly in the extracranial region, some patients may experience "tandem stenosis". This is nothing more than a combination of damage to the arteries in the intracranial and extracranial sections.

If the internal carotid artery is often affected by atherosclerosis, then atherosclerotic changes are not observed in the external ones. This picture proves the importance of anastomoses between these vascular systems.

• In the human head, in the wall of the main section, unlike the arteries of other organs, there is no muscular-elastic layer between the internal elastic membrane and the endothelium.
• If we take the walls of the vessels of the main sections in the head, then they are much thinner than the walls of arteries of the same size located in other organs.
• In this department, the elastic membrane is very strongly developed. It contains formations called “Polster” pillows. As a rule, they contain many elastic and smooth muscle fibers, have rich innervation and are localized in the place where the vessels begin to branch.

• Carotid atherosclerotic plaques do not contain too many lipids, but at the same time they contain a lot of collagen.
• Atherosclerotic plaques of the carotid type, in contrast to the coronary ones, which carry a huge amount of lipids, have a fibrous structure and a more pronounced "stenosing" effect.
• Structurally, carotid atherosclerotic plaques have a strong structural heterogeneity.

• Carotid plaques are destroyed according to the mechanism of formation of dissection or intramural hematoma. It occurs due to damage to the resistant walls of the arteries under the systolic impact of the flowing blood.
• Damage to carotid plaques saturated with lipids. This leads to the occurrence of arterio-arterial embolism, and this in turn gives rise to the formation of atherothrombotic strokes and ischemic attacks.

• In the cerebral vessels, receptors are very close and densely located to cytokines. For the prevention of recurrent cerebrovascular "episodes" Dipyridamole is well used. However, in the prevention of ischemic vascular damage in the lower extremities and in recurrent coronary complications, the effectiveness of the drug is much lower.
• The density of purine receptors of type P2 is somewhat lower than on the membranes of endothelial cells of the coronary arteries and platelet membranes. This is how this explains the sensitivity of not cerebral, but coronary vessels to the attack of antiplatelet agents of the thienopyridine group, which lead to blocking of P2 receptors.

Symptoms of atherosclerosis of the main arteries

Depending on the type of damaged main artery, various symptoms will appear:

• Noises in the ears.
• Decreased short-term memory.
• There are disturbances in speech or gait, as well as other disorders of the neurological type.
• There are dizziness or headaches of varying strength.
• The patient has difficulty falling asleep. He often wakes up at night, but at the same time experiences sleepiness during the day due to general overwork of the body.
• There is a change in character: a person can become overly suspicious, anxious, whining.

• Early fatigue when walking. The patient becomes very tired when walking a long distance.
• Gangrene of the extremities may develop.
• When the patient's hands are affected, their cold state is observed. In this case, ulcers may develop on the hands or small wounds may bleed.
• When the legs are affected, the patient develops lameness.
• Dystrophy of the nail plates, a decrease in the size of the calf muscles and hair loss on the lower extremities were noted.
• Decreased pulsation in the legs.

A description of atherosclerosis of the aorta of the coronary arteries can be found here.

Surgery

Of all the existing diseases, a stroke of the brain has not only a huge frequency of formation, but also a high complexity of the course, accompanied by a fatal outcome or disability.

It is possible to treat a stroke caused by damage to the intracranial great vessels by shunting - creating extra-intracranial anastomoses.

Considerable attention is paid to the treatment of atherosclerotic damage to the main arteries in the head even in the pre-stroke stage, when patients are exposed to a lack of blood supply or transient ischemic attacks.

First, a proper examination is carried out, and then a method of surgical intervention is chosen. The operation is performed in patients with various injuries of the vertebrobasilar and carotid pools. Allocate contraindications as relative and absolute indications for operations.

Indications and contraindications for carotid endarterectomy

• Asymptomatic narrowing in the carotid arteries. At the same time, Dopplerographic indicators of stenosis are more than 90%.
• Asymptomatic narrowing in the carotid arteries with indications up to 70%.
• Stenosis of the carotid arteries with indications of 30-60%, accompanied by manifestations of a neurological nature.
• Rough carotid narrowing with contralateral carotid thrombosis and ipsilateral neurologic symptoms.
• Rough carotid narrowing, which has complications of stroke with the formation of aphasia or hemiparesis (not earlier than 30 days after the stroke).
• Gross carotid narrowing with manifestation of a cardiac embologenic cause of stroke and ipsilateral symptoms (all confirmed by atrial fibrillation or echocardiography).
• Rapidly developing narrowing of the carotid type.
• Gross carotid narrowing with symptom of ipsilateral amorrhosis fugax.
• Rough carotid narrowing with a complete stroke that occurred in the basin of the damaged artery.
• Rough carotid narrowing that occurs before coronary artery bypass surgery and is asymptomatic.

• The formation of a heterogeneous type of plaque at the mouth of the carotid artery of the ICA, which can occur even with asymptomatic stenosis.
• The occurrence of carotid stenosis with clinical manifestations of decompensated encephalopathy of the discirculatory type or transient ischemic attacks.

This also includes patients who are at risk of cerebral stroke, suffering from diabetes mellitus, high blood lipids, arterial hypertension, who belong to advanced age, or who smoke a lot.

• Thrombosis in the carotid artery, accompanied by ipsilateral symptoms of a neurological type.
• Transient ischemic attacks observed in the vertebrobasilar basin.
• Gross carotid narrowing with very complex ipsilateral stroke accompanied by hemiplegia or coma.
• Carotid narrowing (reading less than 30%) with ipsilateral neurologic deficit.
• Manifestation of non-hemispheric symptoms in verified severe carotid stenosis, such as excessive fatigue, headache, syncope, etc.
• Rough carotid narrowing, accompanied by symptoms of damage to the opposite cerebral hemisphere.
• Rough carotid narrowing with the presence of ipsilateral symptoms and severe comorbidities (damage to the CNS of an organic nature, cancer metastases, etc.).

Types of CEAE

There are several variations of CEAE. Namely: eversion, open, as well as various methods of arterial prosthetics using hetero- and homografts and veins.

The choice of the method of surgical intervention depends on how damaged the carotid pool is and what is the area of ​​the lesion. The optimal surgical intervention is eversion and direct endarterectomy.

In the case of eversion - the duration of the operation is much less. In addition, the geometric parameters of the reconstructed vessel are subject to minimal changes.

When is vertebral artery reconstruction needed?

• stenosing process that occurs at 75% of the degree of stenosis of two vertebral arteries simultaneously;
• narrowing of the dominant vertebral artery with an indicator of 75%;
• segmental occlusion in the second segment of the vertebral artery, which occurs when there is hypoplasia of the other.

Surgical restoration of pathologies in the first section of the vertebral artery occurs due to endarterectomy of the mouth of the artery, carried out through the supraclavicular access.

If the procedure cannot be performed, due to damage to the subclavian or vertebral artery, then the movement of the artery is performed, i.e. perform spinal-carotid shunting.

subclavian artery

Surgical intervention in the subclavian artery is performed when:

Most often, the mechanism for the formation of these symptoms is any serious limitation of blood flow as a result of critical stenosis or embolism of the main arterial vessel due to ulceration of an atheromatous-type plaque.

Depending on where the damaged sections of the main trunk are located, they decide which access to carry out: supraclavicular or transsternal.

The need for an extra-intracranial anastomosis

• Hemodynamically significant stenosis of the intracranial sections in the pools of the posterior, middle, or anterior arteries.
• Damage to the internal carotid artery of a tandem nature with a reduced degree of tolerance of the brain of the head to ischemia, in cases where a multi-stage surgical intervention is recommended.
• ICA thrombosis accompanied by depletion of collateral circulation reserves.
• The first stage before carotid endarterectomy performed on the ipsilateral side with the absence of normal collateral blood flow through the circle of Willis.
• Bicarotid stenosis, accompanied by tandem damage to one of the carotid: first, the first stage is performed - normal patency of the carotid artery, contralateral to the tandem damage, is restored, and then stepwise application of EICMA.

It is worth pointing out that X-ray endovascular angioplasty is performed only with excellent technical equipment. It is best to use endovascular type angioplasty for local stenoses.

Medical therapy

For drug treatment, as a rule, are prescribed:

Also, patients are prescribed for life the use of aspirin derivatives that reduce the likelihood of blood clots, for example, thrombo-ass or cardiomagnyl. Vitamin therapy is also prescribed to maintain organs and tissues that do not receive proper blood circulation in a normal state.

Description of atherosclerosis of the arteries of the brain you will find here.

Learn more about stenosing atherosclerosis and its consequences.

Atherosclerosis is a very serious problem. Therefore, it must be identified at an early stage in order to be able not only to start treatment on time, but also to change your lifestyle to prevent the development of the disease into a more serious stage.

Damage to blood vessels are among the most dramatic in terms of intensity and speed of developing consequences. Perhaps there is no other injury where emergency care would be so necessary and where it would not save a life with such obviousness as with arterial or venous bleeding. There are many reasons that cause damage to blood vessels. These are open and closed injuries, wounds. Among the civilian population, 1/3 recorded simultaneous damage to blood vessels and the heart, and in more than 80% of cases these injuries were either of gunshot origin or inflicted with cold weapons. Vascular injuries predominate in wounds of the extremities, with penetrating wounds of the abdomen.

With the development of firearms, the proportion of wounds to blood vessels in relation to the total number of wounds began to gradually increase. Since about 1900, when lighter bullets of a smaller caliber appeared in the arsenal of the armies, there were relatively more vessel wounds.

According to Nguyen Hanh Zy, in case of gunshot wounds of blood vessels, the share of isolated injuries of arteries is 47.42%, isolated injuries of veins - 6.77%, and combined injuries of arteries and veins account for 45.8% of the total.

Localization of injuries, according to the same author, can be represented as follows: neck (carotid arteries, jugular veins) - 8.96%, vessels of the shoulder girdle and upper limbs - 16%, vessels of the abdominal cavity and pelvis - 11.55%, vessels of the lower extremities - 63.40%.

Traumatic injuries of the brachycephalic branches are relatively rare and account for about 6-7% of the total number of arterial injuries.

The most severe are shrapnel wounds, in which there is a combined damage to the artery, vein and nerve trunk, accompanied by a clinical picture of traumatic or hemorrhagic shock.

Combined injuries of the artery and nerves account for approximately 7% of all vascular injuries.

Traumatic arterial aneurysms lead to various kinds of complications in approximately 12% of cases, and arterial-venous fistulas - in at least 28% and, above all, to cardiac disorders.

Apparently, there is reason to divide damage to blood vessels into three groups:

• damage (most often ruptures) of arterial and venous trunks that occur with closed injuries;
• injuries in open injuries (wounds, fractures)
• with gunshot wounds.

It is also important to distinguish between damage to blood vessels, accompanied by a defect in the vascular wall, which is most often observed in gunshot wounds, and without a defect, which is typical for wounds with knives. When an artery is ruptured, for example, as a result of a dislocation in the knee or elbow joint, a defect necessarily occurs, since when stretched, all three layers of the artery are torn at different levels due to their different mechanical strength.

When an artery is injured, the wall may be stratified over a large distance from the injury site.

There are many classifications of damage to the central and peripheral blood vessels, but for practical purposes, a fairly simple classification is needed, from which diagnostic and therapeutic measures would be obvious.

It is known that to damage the walls of the main venous and especially the arterial trunk, a sufficiently large force is required, taking into account the high degree of their elasticity. Even when exposed to such a factor as a firearm (bullet or shrapnel), the vascular bundle often moves away from the emerging wound channel. In case of damage to a blood vessel by any wounding projectile (shrapnel, bullet) or bone fragment, the following injuries are possible.

• Damage to a part of the wall of an artery or vein with the formation of a "window" from which arterial or venous bleeding immediately begins into the surrounding tissue and outward with a fairly wide lumen of the primary wound channel. A more detailed division of damage to the wall of an artery or vein into 1/3 3/4 of the lumen does not add anything significant for diagnosis and treatment.
• Total damage (complete interruption) of an artery or vein, or both. In this case, there may be two options:
  • massive prolonged bleeding from both ends of the vessel, leading to rapid and severe blood loss;
  • screwing the intima of the artery into the lumen, as a result of which the bleeding stops, for example, with a traumatic separation of the limb at the level of the shoulder joint. In this case, bleeding may be moderate. With a complete break in the large venous trunk, the intima is not screwed inward, therefore, venous bleeding with injuries of various origins is sometimes even more dangerous than arterial bleeding.

In the case of simultaneous damage to the artery and the vein accompanying it, an arteriovenous fistula is likely to occur, the essence of which is that through the cavity formed in the tissues there is a communication of the lumens of the main artery and vein. This is a serious complication, fraught with serious hemodynamic changes due to shunting of the arteriovenous bed. Subsequently, with such injuries, an arteriovenous false aneurysm is formed. Looking ahead somewhat, it can be noted that post-traumatic, especially gunshot origin, aneurysms tend to suppurate. It is easy to imagine the consequences of opening such a phlegmon!

Injury to the artery can remain unrecognized for a long time, and only the formation of a false aneurysm, which, due to the ingress of thrombotic masses into the peripheral segment of the artery, can give acute occlusion, makes it possible to make a correct diagnosis.

The occurrence of arteriovenous fistulas is not uncommon. These fistulas are especially dangerous in the neck, since the occurrence of heart failure is real due to the discharge of arterial blood into the superior vena cava. An unrecognized injury, such as the popliteal artery, inevitably leads to ischemic gangrene of the leg.

It should be emphasized that the compensatory capabilities of collaterals in case of damage to the main arteries, accompanied by soft tissue damage, are significantly reduced. Therefore, the period that is considered acceptable in case of injury to the main arteries is 5 hours from the moment of injury, in cases of severe injuries it may turn out to be too long. That is why such victims should be helped as soon as possible.

During the Great Patriotic War, damage to blood vessels was not recognized in approximately 1/3 of cases. In peacetime, this figure is no less, despite the obvious advantages of diagnostics compared to wartime.

Symptoms of damage to the main blood vessels

Wound in the projection of the blood vessel. This fact must always be taken into account by the physician examining the patient. It should be taken as a rule: at the slightest suspicion of damage to the main artery, apply all the necessary diagnostic techniques to remove or confirm this diagnosis.

Bleeding. External bleeding naturally occurs only with open injuries. It can be considered practically beyond doubt that only on the basis of external bleeding, with the exception of those cases when a stream of arterial blood pulsates in the wound, it cannot be said whether there is damage to the main artery or not. This is especially true for gunshot wounds, injuries caused by the explosion of anti-personnel mines, always accompanied by massive widespread soft tissue damage.

Of course, external bleeding from an artery or vein is the most striking symptom of damage. It should be borne in mind that pulsating bleeding with scarlet blood is not always observed, and with closed injuries of the arteries, it naturally does not exist. Even with severe fractures with damage to the artery, gunshot bullet and shrapnel wounds, external pulsatile bleeding is observed infrequently. Therefore, from the point of view of further tactics, in any case of intense external bleeding, damage to the main artery or vein should be suspected. Viewing damage to the main artery is fraught with serious and irreversible consequences.

Determination of the pulsation of the artery distal to the site of injury. The preserved clear pulsation on the dorsal artery of the foot, the radial artery indicates the integrity of the main trunk proximal to the injury site. But not always.

In the absence of pulsation in the periphery, there is reason to think about the cessation of blood flow in the area of ​​damage, but not always either. If the victim is in a state of shock, collapse due to blood loss, and systolic blood pressure up to 80 mm Hg. Art. and less, the pulsation of the artery can not be determined while maintaining the integrity of the main artery. In addition, with a gunshot wound of soft tissues and the anatomical integrity of the artery, a spasm of the vessel necessarily occurs as a result of the effect of the so-called side impact, in essence a hydrodynamic wave that occurs at the moment a bullet or fragment hits the tissues of the human body.

V. L. Khenkin, in wounds of the axillary, brachial, iliac, femoral and popliteal arteries, only in 38% of cases found the absence of a pulse, in the rest the pulse was either weakened or preserved.

An important sign of injury to a large arterial trunk is swelling caused by a hematoma, but an even more important sign is the pulsation of such swelling, which is relatively easily determined by eye.

With the formed arterioveal fistula, the symptom of "cat's purr" can be determined.

A pulsating hematoma, and later a false aneurysm, is usually quite distinct in the form of a relatively well-defined swelling. In the case of an arteriovenous aneurysm, the swelling is less; in an arterioveal fistula, it may be absent.

In no case should we forget such a simple method of research as auscultation in the circumference of the wound, at least a little suspicious in relation to the probable damage to the artery. The systolic blowing noise at injury of an artery is very characteristic.

It is impossible to ignore the pallor of the skin of the limb on the periphery of the wound. Wounds of large arterial highways may be accompanied by such signs as paresthesia, paresis; at a later date, ischemic contracture develops.

In peacetime vascular injuries, blood loss is the most common symptom of acute injury to the main blood vessels, especially in injuries of the subclavian, iliac, femoral, and popliteal arteries. Clinical signs of acute blood loss are noted in almost all cases of injuries of the listed vessels, however, with injuries of vessels located more distally, clinical signs of acute blood loss are not detected in approximately 40% of cases.

An absolute sign of damage to the main artery is ischemic gangrene of the limb - a late and not very comforting symptom.

Diagnosis of damage to the main blood vessels

An indisputable diagnosis can be made by vasographic radiopaque examination. It should be emphasized that vasography is mandatory at the slightest suspicion of injury to the main artery.

In the conditions of a specialized hospital for diagnostic purposes, methods of capillaroscopy, contact and remote thermography can be applied.

Paradoxically, but ischemic pain in case of damage to the main artery is not as intense as in case of segmental occlusion of the artery by a thrombus. It is possible that they are to a certain extent masked by pain in the area of ​​damage. Nevertheless, pains on the periphery in relation to the area of ​​damage, which were not previously present and which are clearly related in time to the moment of injury, must be taken into account during the clinical examination of the patient.

The study of peripheral blood indicates blood loss. Hemodynamic shifts in arterial injury are also directly related to blood loss and intoxication from the primary lesion in the first hours after injury, and later from ischemic tissues.

Biochemical indicators indicate a focus of ischemia and necrosis, but these data can hardly be attributed to pathognomonic signs.

As noted, arteriography is mandatory both for the undoubted clinical diagnosis of arterial damage, and for suspicion of such. An arteriographic study can be performed with sufficient reliability using any X-ray machine, including a ward one.

If the main artery of the lower limb is damaged, the following sequence of actions may be recommended.

The victim is placed on the table. The femoral artery is exposed with a projection vertical incision 50-60 mm long under local anesthesia with 0.5% novocaine solution. Premedication should consist of an injection of 2 ml of 1% morphine solution and 0.5 ml of 0.1% atropine solution. As a radiopaque substance, you can use any water-soluble preparation with a concentration of not more than 50-60%. We strongly recommend not to catheterize the artery through the skin, but to expose it, primarily because this excludes the possibility of paravasal hematoma and subsequent bleeding from the vessel puncture, especially if postoperative heparin therapy is required. The open method allows you to very accurately insert the catheter into the lumen of the artery, which is important for atherosclerotic changes in the arterial wall in an elderly patient. With the open method, paravasal blockade is very well carried out, which must be done by injecting 15-20 ml of a 1% or 2% solution of novocaine. This is necessary both from the point of view of spasm of the most superficial femoral artery, and from the point of view of opening the peripheral arterial collateral network. And finally, which is also very important, with the open method, at the time of the injection of a contrast agent, it is possible to pinch the central segment of the artery with a tourniquet or soft vascular clamp to temporarily stop blood flow. This greatly improves the quality of the image. Before the introduction of a contrast agent into the arterial bed, it is necessary to introduce 20-25 ml of a 0.5% solution of novocaine through a catheter into the lumen of the artery to relieve unwanted, including interoceptive, pain effects.

An x-ray is taken at the height of the injection of a contrast agent, the catheter is not removed, but the image is waiting for the development. In the case of sufficient information content of the radiograph, the catheter is removed and it is best if the surgeon applies a superficial suture to the adventitia of the artery using atraumatic suture material. It is permissible to stop bleeding from a puncture of the arterial wall by pressing it with a gauze ball for several minutes. After the bleeding has stopped, the wound is either sutured, if no evidence of arterial injury is obtained, or left open, retaining the previously applied tourniquet.

Arteriograms are the most reliable diagnostic document, which confirms not only the fact, level and extent of damage, but also allows you to judge the degree of viability of collaterals.

Among the non-invasive methods for diagnosing lesions of the main vessels, the main role is currently played by ultrasound flowmetry - Dopplerography. The method based on the registration of moving objects makes it possible to determine the presence of blood flow in a given section of an artery or vein, its direction and speed in various phases of the cardiac cycle, and the nature of the flow, depending on the properties of the vascular wall. According to different authors, the diagnostic accuracy of the Doppler method for occlusive lesions of the arteries of the extremities is 85-95%, for diseases of the veins - from 50 to 100%.

The standard examination scheme includes the location of the main vessels at certain points of the upper and lower extremities, characterizing the blood flow in various segments of the vascular bed. Dopplerogram analysis consists of a qualitative assessment of the curve and the calculation of quantitative parameters. To improve the accuracy of diagnosis, regional systolic pressure is measured at the level of various segments.

The use of Doppler ultrasound in traumatology includes the diagnosis of thrombotic vascular lesions, acute and chronic traumatic injuries, dynamic control during treatment. With massive injuries of the soft tissues of the extremities, accompanied by edema of the distal sections, the clinical diagnosis of vascular lesions is difficult, especially in patients with prolonged crush syndrome. In two of these patients, there was no pulsation on the posterior tibial artery and the dorsal artery of the foot by palpation, however, Doppler sonography was able to determine the antegrade blood flow in both arteries, which indicated that the vascular patency was preserved. The curve parameters were significantly changed as a result of compression of the arteries by edematous tissues and bone fragments, but a clear positive trend was noted during the treatment. Examination of the dorsalis pedis artery revealed retrograde blood flow due to complete rupture of the anterior tibial artery and blood flow from arterial anastomoses of the foot in one patient with an open fracture of the shin bones and prolonged crush syndrome. Later, as a result of a purulent process and arterial ischemia, necrosis of the foot tissues occurred, which led to amputation.

Dopplerography is also of great importance in chronic arterial injuries for choosing the tactics of surgical intervention and predicting the postoperative course. In these cases, the data on the state of individual arteries are successfully supplemented by integral indicators of the blood supply to the limb segment, obtained using rheography, thermography and other methods.

Treatment of damage to the main blood vessels

Medical care for injuries of blood vessels:

Measures for wounding blood vessels should be divided into urgent, urgent and final. The first in the form of stopping bleeding by applying a tourniquet, pressure bandage, pressing the vessel, forced flexion of the limb is carried out, as a rule, at the scene or in the vehicle in which the victim is evacuated.

In practice, in the vast majority of cases, hemostasis is carried out using natural mechanisms, and the condition for stopping bleeding is the fastest delivery of the wounded to the stage of qualified surgical care. To reduce the negative effect of the tourniquet, it is recommended to apply plywood tires from the side opposite to the location of the vessels, and the tourniquet should be applied as close as possible to the area of ​​the damaged vessel.

Thus, when providing first medical aid, it is desirable to further temporarily stop bleeding not with a tourniquet, but with other methods, for example, tight tamponade of the wound, using a pressure bandage. For vein injuries, a pressure bandage is usually sufficient to stop bleeding.

In a person admitted with a tourniquet, it is necessary to determine the reliability of damage to a large vessel, the possibility of replacing the tourniquet with another method of temporarily stopping bleeding; imposition of a hemostatic clamp, ligature, stitching of the vessel in the wound. If this fails, then the vessel is pressed for 10-15 minutes with a finger, and then, placing a piece of plywood tire or thick cardboard under the tourniquet on the surface of the limb opposite to the projection of the vascular bundle, tighten the tourniquet again. When bleeding from wounds of the gluteal region, popliteal fossa, you can resort to tight tamponade of the wound with suturing the skin over the inserted tampon with several knotty silk sutures. When evacuating a wounded person with a tourniquet in the cold season, the possibility of hypothermia of the limb should be prevented. In the conditions of the arrival of a mass flow of the wounded, the volume of assistance is reduced to the provision of first aid for health reasons and is limited to stopping bleeding with the help of tourniquets or pressure bandages.

Urgent plan activities are most often carried out at a stage where there is no vascular surgeon and it is impossible to provide specialized assistance. In this case, temporary shunting of the artery or, in extreme cases, ligation of it in the wound or throughout can be applied.

In a specialized hospital, assistance is provided using all modern diagnostic and treatment tools that are designed to restore blood flow in the most appropriate way for this particular situation.

In any case of a temporary stop of bleeding, it is necessary to indicate the exact time when this procedure was performed. In a known infected wound, when an artery is injured, a vascular suture should be applied, subsequently ensuring good reliable drainage in the anastomosis zone, the introduction of powerful antibacterial agents, and good immobilization of the operated limb.

Essential in preoperative diagnosis is the determination of the degree of ischemia.

From a practical point of view, it is advisable to divide limb ischemia into two groups - compensated and decompensated. In the first case, surgical restoration of arterial patency is indicated, which will lead to complete restoration of blood flow and almost complete restoration of limb function.

For decompensation of blood flow: loss of active movements, loss of pain and tactile sensitivity - even immediate restoration of blood flow by surgery does not guarantee the anatomical integrity of the limb.

In cases of clearly necrotic changes in the limb, amputation is indicated. The demarcation line is most clearly manifested after 24-48 hours from the moment of cessation of blood flow and the development of symptoms of circulatory decompensation in the limb.

B. V. Petrovsky (1975) distinguishes 4 stages of ischemia:

• acute ischemic disorders;
• relative compensation of blood circulation;
• circulatory decompensation and
• irreversible tissue changes.

V. A. Kornilov (1971) proposes to take into account two degrees of ischemia in case of vascular damage: compensated ischemia, characterized by the absence of sensory and motor disorders; uncompensated, which is divided into stage I (there are motor and sensory disorders, but there is no ischemic contracture) and stage II - with the development of ischemic contracture.

Restoration of blood flow should be carried out with uncompensated stage I ischemia no later than 6-8 hours, with stage II ischemia, restoration of blood flow is contraindicated.

VG Bobovnikov (1975) proposed his own classification of limb ischemia. The experience of Yaroslavl specialists in vascular surgery convincingly testifies in favor of the fact that it is expedient to operate on victims with injuries of the main arteries by mobile teams where the patient was delivered. This allows about 50% of the victims to be operated on in the first 6 hours.

The place of treatment for such patients is a trauma hospital.

There is no doubt that in patients with combined injuries, surgery should be carried out by two teams of surgeons - traumatologists and specialists in vascular surgery.

In some cases, with severe injuries, it is advisable to catheterize one of the collaterals for regional perfusion. In preparation for surgery, the skin should be treated: in case of damage to the axillary or subclavian blood vessels from the fingertips to the anterior surface of the chest; when the femoral artery is injured in the upper third, the entire limb and skin of the abdomen are treated.

It is rational to put on a sterile plastic bag on the foot or on the hand, which allows you to monitor the state of skin color and pulse. It is necessary to remember about the probable need to take a free venous autograft, therefore, the second healthy lower limb should be prepared in the same way.

The most important condition for the success of a restorative intervention on the main artery or vein is a sufficiently wide projection approach, since in cases of a complete interruption of the artery, its ends diverge far to the sides and it is not easy to find them in altered, blood-impregnated tissues. This is typical for bullet and especially shrapnel wounds.

Therefore, in principle, the arterial trunks, regardless of the level of damage, must be exposed by projective incisions. This is also important because with the anatomical approach of the artery, there are more conditions for preserving collaterals, which must be spared in every possible way. With any type of arterial plasty (autovein, synthetic prosthesis), it is necessary to cut out the ends of the damaged vessel in order to refresh them and create conditions for an ideal comparison of all three elements of the blood vessel wall. This is the main and decisive condition for the success of an operation on an artery or vein. Naturally, such measures increase the defect of the vascular trunk and create certain technical difficulties.

The need for vascular reconstruction for emergency indications may arise in any surgical or trauma hospital. Owls of the main artery or vein, or plastic surgery of an autovenous artery with its large defect can be performed using only general surgical instruments, but with the obligatory presence of atraumatic suture material. First, it is necessary to isolate, mobilize and take the central end onto the turnstiles. With the ends of the artery or vein isolated and taken on clamps or tourniquets, they should be handled with the utmost care, even if it is only a parietal injury, since it largely depends on whether postoperative thrombosis occurs at the suture site or in the graft or not. It is better to use tourniquets rather than clamps at the central and peripheral ends of the vessel, since they cause less trauma to the vessel wall and provide the surgeon with greater freedom of manipulation in the wound.

In the case of parietal damage to the artery, separate sutures should be applied in the longitudinal direction with respect to the vessels, trying to deform the lumen of the artery or vein as little as possible. You should carefully make sure that the intima is not damaged, not wrapped in the lumen of the vessel. If, when suturing a parietal wound of an artery or vein, a gross deformation occurs, the vessel should be completely dissected and a circular vascular suture performed, an end-to-end anastomosis should be performed.

During emergency operations on blood vessels, it is better to use mainly the Carrel suture as the most easy to perform and quite reliable. The same suture should be performed when implanting an autovenous graft into an artery defect.

The suture material should be selected according to the diameter of the blood vessels to be sutured. It is better to use a monofilament atraumatic suture. After performing an anastomosis or anastomoses, in the case of a venous insertion, first of all, the peripheral clamp or tourniquet is removed so that the retrograde blood flow completes the area of ​​the anastomosis or plastic reconstruction. You can then remove the center clip or turnstile. Almost always after this, bleeding from individual punctures of the wall is observed. This bleeding, as a rule, stops quickly, and additional stitches should not be rushed. In case of intensive bleeding with a jet of 1-2 injections, a superficial atraumatic suture should be carefully applied.

To replace part of the arterial wall, the great saphenous vein is predominantly used. It is carefully dissected by bandaging the lateral branches, otherwise intense bleeding occurs from them, which can only be stopped by ligating the lateral trunks. The vein must be rotated 180° before transplantation - valves! The calibers of the transplanted vein and artery rarely coincide completely, so quite often it is necessary to "bring to the same diameter" the vein and artery with the help of sutures.

When processing the ends of the artery, it is advisable to perform thrombectomy to extract the thrombi formed there, best of all using a Fogarty-type balloon catheter. An autovenous graft can be used as follows. An end-to-end anastomosis is in principle the best, since it does not create any lateral "pockets". However, if there is no confidence in the reliability of the end-to-end anastomosis, if the operation is performed in a known infected wound, it is possible to perform a bypass shunt from an autovein with an anastomosis of the end-of-vein-to-artery-side type.

In case of damage to the vein of the same name and the presence of a suitable size of the venous autograft (which is unlikely), it is possible to perform a veno-venous anastomosis.

A synthetic vascular prosthesis is not used in cases of open and closed vein injury. Thanks to the vast experience of vascular surgeons in many countries, it can be considered reliable that any synthetic vascular prosthesis with a diameter of 7 mm or less will inevitably thrombose. With open injuries, there is a high risk of microbial contamination of the prosthesis and subsequent, albeit slight, suppuration. This, in turn, will lead to the inevitable removal of the prosthesis, since there is no method of preserving it in a purulent wound today, and the risk of its rupture under these conditions with profuse bleeding is quite high.

In the postoperative period in this category of patients, suppuration can cause sudden profuse arrosive bleeding, which within a few minutes leads to bleeding of the patient and requires the most energetic efforts on the part of the medical staff on duty.

In a certain percentage of cases, with slowly developing thrombosis, therefore, with a gradually stopping blood flow in the main arterial line, the collateral blood flow has time to open, which successfully takes on the function of blood supply to the limb. It is also known that simple ligation of an artery does not always lead to limb necrosis.

At one time, special rigid endovascular prostheses were developed from special grades of plastics, which, in the event of an acute injury to the main artery and if, for one reason or another, it was impossible to perform a vascular suture or vessel plasty at this stage of emergency surgical care, they were inserted into the refreshed ends of the artery and fixed there with two ligatures on each side. The blood flow through such a tube is maintained for several hours or days, which makes it possible either to transport the victim to where he will be provided with specialized assistance, or this may not be required if a sufficient collateral network develops with gradually developing endoprosthesis thrombosis.

An operation on the arteries should be accompanied by the introduction of a 0.5% solution of novocaine into the vascular case, constant irrigation of the surgical field and especially the inner lining of the vessels.

With a pulsating aneurysm or an arteriovenous fistula formed, operations are usually performed not for urgent indications, certainly within the walls of specialized hospitals.

Operations for a pulsating aneurysm or an arteriovenous fistula should be provided with a sufficient amount of better blood of the same group; The surgeon must have at least two assistants. The intervention begins with the obligatory isolation of the artery and the accompanying vein proximal and distal to the aneurysm, the vessels are exposed by projection incisions.

The distal and proximal sections of the artery are taken on reliable tourniquets or vascular clamps. After that, they proceed to the careful dissection of the aneurysmal sac, which, as a rule, contains liquid blood, clots with elements of their organization, and wound detritus. It is mandatory to take material from the aneurysm cavity for histological and microbiological studies. Gradually separating the trunk of the artery and immediately ligating the bleeding vessels, they reach the highways, which are isolated and also taken to the vascular clamps.

During surgery for an aneurysm, it is quite rare to impose an end-to-end anastomosis, so most often you have to resort to autovenous plasty. If the defect is in the wall of the accompanying vein, it should be carefully ligated as far as possible from the aneurysm. It has been established that the suture of the accompanying vein at the level of the middle and lower thirds of the thigh, on the lower leg, if performed insufficiently carefully, inevitably leads to thrombosis at the site of the anastomosis. After washing the aneurysm cavity with a 0.25% novocaine solution, it is irrigated with antibiotic solutions (kanamycin), the wound is sutured tightly in layers, leaving reliable silicone graduates or, better, corrugated drains made of a thin polymer film. It should be emphasized the need for mandatory closure of the anastomosis line or autograft with soft tissues. The optimal period for surgery for complications of vascular injuries should be considered from 2 to 4 months after the injury.

After intervention on the subclavian and carotid arteries, it is advisable in the postoperative period to give the victim the position of Fowler.

The issue of prescribing anticoagulants in the postoperative period is not an easy one. It should be noted that with careful execution of the vascular suture with a complete comparison of the inner walls of the sutured vessels, anticoagulants, in particular heparin, may not be used in the postoperative period.

An important condition is the maintenance of stable hemodynamic parameters, since a decrease in blood pressure to 90-80 mm Hg. Art. fraught with the formation of blood clots at the site of the anastomosis.

Mandatory in this category of patients is the study of peripheral blood for coagulation, which should be performed every 4 hours. sodium chloride solution, Ringer-Locke solution. Heparin is administered until the blood clotting time increases to 12-17 minutes, maintaining this indicator at this level for 3-4 days. The use of coumarin anticoagulants in patients who have undergone reconstructive surgery on the blood vessels of the extremities is undesirable. The main danger in this case is the occurrence of a paravasal hematoma with its subsequent suppuration.

Damage to the arteries of the neck, chest, abdominal cavity. If the surgeon finds a completely damaged external carotid artery, which inevitably leads to an ischemic stroke, the artery should not be restored in this case, since the renewed blood flow will turn the ischemic stroke into a hemorrhagic one with all the ensuing consequences.

In cases of neck injury with continued bleeding, a revision of the carotid arteries should be made, which is best done with an incision along the anterior edge of the sternocleidomastoid muscle.

When large blood vessels of the chest are injured, especially in its upper sections, access through a median sternotomy is advisable. Vertebral arteries are extremely difficult to suture, so it is advisable to ligate them. Longitudinal sternotomy is indicated for injury to the heart, ascending aorta; in case of damage to the descending aorta, a thoracotomy is performed in the position of the patient on the right side. In case of injury to the celiac trunk, surgical treatment is possible only through a thoracoabdominal incision with a dissection of the diaphragm. The celiac trunk can rarely be restored, more often it has to be bandaged. The superior mesenteric and renal arteries should be repaired; most often, however, this can only be done using a venous autograft. The inferior mesenteric artery can be ligated, although today, with the possibilities of microsurgical wound dressing, it is quite possible to raise the question of its restoration.

Damage to the arteries and veins of the shoulder girdle, upper and lower extremities. Wounds of the axillary artery are rarely isolated. Possible combined damage to the elements of the sub-aortic plexus: veins, large nerve trunks. In any case, first of all, it is necessary to restore blood flow through the main arteries. The greatest difficulties arise when isolating and stopping bleeding from the central ends of the veins, arteries, sometimes you have to resort to exposing the axillary artery.

It is rather difficult to connect the ends of the axillary artery with a direct anastomosis. Most often it is necessary to use an autovenous insert, which should be taken from the great saphenous vein of the thigh. It should be remembered that the axillary vein is unlikely to be sutured, so you should try your best to maintain collateral blood flow.

Restoration of blood flow in the brachial artery is relatively easy; here more often than in other situations, it is possible to perform end-to-end anastomosis.

In the event of a simultaneous fracture of the humerus and damage to the artery, bone fragments should first be fixed. Better fixation can be achieved with a "clean" fracture with a CYTO-SOAN plate. For the prevention of ischemic disorders, it is possible to recommend temporary shunting of the central and peripheral segments of the artery with a polyvinyl chloride tube, followed by suturing of the artery or its autovenous plasty. The restoration of blood flow should be completed last, after osteosynthesis, suturing of the nerve trunks (if necessary), ligation or suture of the accompanying vein if it is damaged.

Forearm. The need for a vascular suture in case of damage to the forearm occurs only with simultaneous damage to the radial and ulnar arteries. And in this case, you should start with osteosynthesis by the most appropriate method. In principle, for “clean” fractures, CITO-SOAN plates should be used, for infected injuries, extrafocal osteosynthesis.

Given the small diameter of the arteries of the forearm, it is highly desirable to use microsurgical techniques, to apply anastomoses under a microscope. This guarantees against subsequent postoperative thrombosis.

An essential role, from the point of view of timely diagnosis of retrombosis, is played by continuous monitoring of the limb, the use of special monitors that respond to changes in the temperature of the skin distal to the anastomosis. These systems have an alarm signal that warns the staff on duty about the lack of arterial blood flow. If both arteries of the forearm are damaged, it is best to sew both arterial trunks, but if this is not possible, the patency of the radial or ulnar artery should be restored. Associated veins are usually ligated.

Thigh, shin. The greatest difficulties arise when suturing, which is rarely possible, or popliteal artery plasty. In case of damage to the artery with a dislocation in the knee joint or with an open injury to the artery, one should start by isolating the artery in the adductor (gunter's) canal. The projection incision should be continued into the popliteal fossa on the posterior surface of the lower leg. The greatest difficulty arises if the damage extends to the bifurcation of the popliteal artery. In this case, it is difficult to do without plastic material, and the need to restore arterial blood flow in the popliteal artery is absolute, because its thrombosis inevitably leads to necrosis of the lower leg and foot.

N 18.02.2019

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But the lifestyle of a modern person has changed dramatically: environmental pollution, the predominance of refined foods in the diet, information load, physical inactivity - this negatively affects the state of blood vessels and the entire human body.

However, the medical industry does not stand still, but is developing at a rapid pace - its arsenal contains an impressive collection of effective methods for diagnosing and treating pathological processes in the vessels. Doppler studies of blood flow are considered the most informative and safe - ultrasound (doppler ultrasound) and DS (duplex scanning) MAG (main arteries of the head).

Many patients, having received a referral for examination and seeing a mysterious abbreviation, ask the question: “What is it?” In our article, we want to talk about the advantages of these techniques, when the examination is carried out and what changes in the vessels can be detected during it.

What is dopplerometry?

This diagnostic method got its name on the basis of the discovery of a physical phenomenon made by the Austrian scientist K. Doppler. Its essence lies in the reflection of changes in the frequency of the ultrasonic beam signal from blood cells moving in the vessels. This gives you the opportunity to evaluate:

• speed and direction of circulating blood;
• volume of minute blood flow;
• the presence of atherosclerotic stenosis (narrowing) and blockage of the vessel;
• collateral (lateral) circulation;
• vascular pulsation.

Indications for Doppler sonography

The delivery of blood and oxygen to the brain tissues occurs through the carotid (located on both sides of the lateral surface of the neck) and vertebral (which run on the sides of the spine) arteries. The slightest violation of the blood supply to the brain cells leads to serious deviations in its functional activity.

With the help of modern medical technologies, it is possible to painlessly examine the condition of the veins and arteries of the head and neck in patients with high cholesterol, concussion, spinal injuries, who smoke for a long time.

The procedure is quite fast, but requires high qualification from a specialist.

Practitioners prescribe MAG ultrasound if a patient is suspected of having cerebrovascular accidents, which manifests itself:

• bursting headache;
• numbness and weakness of the limbs;
• impaired hearing, attention and memory;
• frequent dizziness;
• distraction;
• noise in the head;
• loss of consciousness.

Also, a study of the state of the vessels of the head is carried out to diagnose and monitor the effectiveness of therapeutic measures for such diseases as:

• diabetes;
• atherosclerosis;
• stroke;
• hypertension;
• vasculitis;
• cardiopsychoneurosis;
• osteochondrosis of the cervical spine;
• obesity;
• ischemic disease and heart disease.

However, in some cases, dysfunction of the vascular system may occur without visible clinical symptoms. That is why people over 55 years of age and those who have a burdened family history (presence of hypertension, ischemic stroke, myocardial infarction in close relatives) are recommended to undergo a study once a year.

Features of the diagnostic procedure

No special preparation for a Doppler study is required. The patient can take medications as usual, but before the examination it is worth telling the doctor which medications are prescribed. The only condition for the patient is to give up on the eve of the procedure from smoking and eating products that affect vascular tone - energy and alcoholic drinks, coffee, strong tea. Diagnostics is carried out in a calm environment and comfortable conditions for the patient.

The doctor lubricates the examined areas with a special gel, which improves the glide and sound conductivity of the sensor, and scans the main arteries passing through the neck

Ultrasonic waves penetrate to the vascular system of the brain through the skull, a qualified specialist alternately examines various areas of the head with a linear sensor - supraorbital, temporal, occipital, atlanto-occipital (the area where the spine merges with the occipital bone). In addition to studying the vessels, the doctor conducts functional tests necessary to clarify or confirm disorders of the regulation of the autonomic nervous system.

What can be revealed by Doppler ultrasound of blood vessels?

This diagnostic procedure allows you to detect the formation of blood clots not only in the vascular system of the cervical spine and head, but also in the upper and lower extremities. With the help of ultrasound, you can determine:

• causes of headaches;
• narrowing of the arteries;
• the stage of diseases, the development of which was provoked by atherosclerosis or thrombosis;
• the presence of vascular aneurysms;
• the speed of blood flow in the main arteries and its disturbances;
• condition of the vessels of the spine.

The changes revealed during the diagnostic examination may indicate the development of:

• vasculitis - the echogenicity of the lumen of the vessel, the thickness of its walls and differentiation into layers change;
• atherosclerosis - the thickness of the diameter of the vascular walls increases, an uneven type of change in echogenicity appears;
• cholesterol plaques in the arteries - hypo-echogenic formations with a thin rim are found.

MAG ultrasound can detect deformation of the vascular walls of the neck - a harbinger of coronary heart disease

Analysis of indicators of vascular diagnostics

Dopplerography is considered a “blind” technique for scanning blood vessels, this is due to the impossibility of visualizing blood flow. However, this procedure is highly informative. The blood circulation of the main arteries is peculiar, it can be divided into:

• Parabolic flow, which is characterized by different shear rates of the middle and near-wall layers. They note the absence of their mixing, at the moment of compression of the vessel, the blood flow velocity is maximum, during relaxation it is minimum.
• Turbulent flow - is formed as a result of the chaotic movement of red blood cells (erythrocytes) on uneven areas of the vascular walls.

Doppler ultrasound reflects such parameters of the Doppler shift as: the rate of blood flow in the middle layers of the vessels and the density gradient of the main blood component - the erythrocyte mass. When analyzing the Dopplerogram indicators, the qualitative and quantitative aspects of blood flows are studied:

• speed - systolic, diastolic and their average value;
• total peripheral vascular resistance - a set of parameters of circulating blood viscosity, vascular tone, intracranial pressure;
• spectral characteristics - a reflection of the number of single-speed shaped cells;
• vascular reactivity, which is determined by the ratio of the duration of blood supply at rest and with exercise;
• mobility - the relative loss of speed.

In some cases, the data obtained at rest is not enough to diagnose the pathological process. Under such circumstances, medical specialists use stress tests - inhalation, holding the breath, taking nitroglycerin, compression of the carotid artery. These methods help to identify diagnostically significant disorders of blood flow through the vessels, characteristic of damage to the main arteries.

A number of pathological processes affect the vascular walls, which can be detected during Doppler sonography. Let's take a closer look at each disease that causes a disorder in the function of the vascular system.

Non-stenosing atherosclerosis provokes an increase in the thickness of the intima-media complex of the carotid artery, pathological uneven thickening of the vascular walls and a uniform change in their echogenicity. With this pathology, the narrowing of the lumen of the blood vessel reaches 20%. Thickening of the carotid arteries up to 0.7 mm, brachiocephalic - up to 1.2 mm is allowed.

Stenosing atherosclerosis is caused by the formation of "plaques", which increase the narrowing of the vascular lumen by more than 25%. Each accumulation of cholesterol cells in the endothelium is evaluated as a potential culprit in the development of acute blockage of the vessel - embolism. That is why their echo density, length, the presence of accumulation of salts (calcifications) and ulceration in the vascular surface are carefully studied.

To assess the likelihood of cessation of blood flow, the structure of the “plaques” that accumulate in the inner lining of the blood vessel is carefully studied.

Horton's disease (giant cell arteritis) causes thickening of the wall of the temporal artery and a decrease in its echogenicity. This phenomenon leads to the formation of small calcifications and damage to the process of differentiation of the vascular walls into layers. Diabetes mellitus is characterized by the development of calcification - an excessive accumulation of calcium on the walls of small arteries.

Hypoplasia of the vertebral arteries is the most common anomaly of the spinal vessels, in which there is a violation of their elasticity with a reduction in diameter and a deviation of the blood flow curve. Patients complain of excruciating attacks of headache and dizziness, which are aggravated by turning the head.

Congenital arteriovenous malformation is characterized by the presence of a complex abnormal intertwining of veins and arteries. As a result of this phenomenon, blood from small arteries bypasses the capillary bed and enters directly into the veins, threatening the efferent vessels with the development of hypertrophy, hyaline degeneration and calcification. Due to the thinning of the walls of the capillaries, hemorrhages and the appearance of an arteriovenous fistula can occur, which leads to damage to the dynamics of cerebral circulation.

UZDG MAG in children

Pediatric doctors recommend conducting a Doppler examination to all newborn babies - a diagnostic procedure helps to identify violations of the circulatory system in a timely manner and take appropriate measures. In the presence of congenital anomalies, diagnosis should be made as soon as possible. Otherwise, this will lead to a delay in the mental and physical development of the child, serious pathologies of the central nervous system.

The study of the arterial circle (willisian) of the child's brain provides an opportunity to identify pathological processes in the early (preclinical) stages of development

Experienced pediatric neurologists prescribe a study of the state of the vascular bed if the baby has headaches, fatigue, memory impairment, mental retardation, and impaired coordination of movements. Diagnosis is necessary to establish an accurate diagnosis and prescribe adequate treatment for such pathologies as migraine, epilepsy, impaired functional activity of the cerebral cortex, laloneurosis (speech defects).

Conclusion

Thanks to the timely detection of diseases of the vascular system, many people can live a long and active life. That is why the advantages of Doppler ultrasound as the main method of early diagnosis of pathological processes are indisputable.

The key to maintaining the health of the human body is an attentive attitude towards it! First of all, ultrasound MAG is necessary to measure hemodynamics and pathological genetics in the circulatory system and detect various anomalies in it. Dopplerography is widely used to monitor the feasibility and effectiveness of a course of drug therapy, to decide on surgical treatment.

Doppler ultrasonography of the main arteries of the head

Ultrasound examination of the head vessels The method of examination of the main arteries of the head is based on the work of ultrasound using the Doppler effect. For examination, special ultrasonic sensors are used to determine both the speed and direction of blood flow in the vessels.

Diagnostics of the arteries of the head and neck

To date, transcranial dopplerography of the main arteries of the head and extracranial arteries of the neck is the most accessible and popular method for studying vascular pathology.

• Extracranial department (located in the area of ​​entry into the cranial cavity)

Being a highly informative method, ultrasonic dopplerography of the extracranial parts of the main arteries of the head and neck has gained great interest in the pathogenesis (mechanism of origin and development) of infarcts.

• Intracranial department (its location area is the cavity and bone canals of the skull)

Pathological processes affecting any of the arteries entail a violation of cerebral circulation. The most popular method for diagnosing pathological changes in blood vessels today is Doppler ultrasound of the mains of the arteries of the head and neck.

Indications for examination of extracranial regions

For the purposes of a diagnostic study, Dopplerography of the main vessels of the neck is carried out if there are certain indications:

• Acute (chronic) cerebrovascular insufficiency

Methods and goals of diagnostics

In practice, the choice of a method for studying vascular pathology depends on the goal (the need to obtain certain data). Identification of the spectrum of vascular lesions is essential for choosing a treatment strategy:

• Hemodynamic disorders are diagnosed using MAG ultrasound of the vessels of the head and neck in a blind way (there is no direct or direct visualization of the vessels).

• Highly informative dopplerography in duplex mode of the extracranial sections of the main arteries of the head and neck makes it possible to obtain comprehensive data confirming or refuting the presence of various pathologies in the vascular system of the brain.

1. Visualization and study of the state of the vessels themselves (their anatomy)

Ultrasound in children

Children are no exception to the development of angioneurology in recent years. Pathological processes affecting cerebral blood flow do not spare young age. Studies of the main arteries in children using the ultrasound method make it possible to timely identify:

Main arteries of the head

Main arteries of the head

Rice. 1. Main arteries of the head and vessels of the base of the brain (scheme).

1 - anterior cerebral artery,

2 - anterior communicating artery,

3 - middle cerebral artery,

4 - ophthalmic artery,

5 - posterior communicating artery,

6 - posterior cerebral artery,

7 - superior artery of the cerebellum,

8 - main artery,

9 - anterior inferior cerebellar artery,

10 - internal carotid artery,

11 - vertebral artery,

12 - posterior inferior cerebellar artery,

13 - external carotid artery,

14 - common carotid artery,

15 - subclavian artery,

16 - shoulder-head trunk,

The internal carotid artery (a. carotis interna) is usually divided into an extracranial section, which includes 2 segments: a sinus and a cervical segment, and an intracranial section, which includes 3 segments: intraosseous, siphon and cerebral. C and n at with is a significantly expanded initial part of the internal carotid artery. It has a rich innervation (baro- and chemoreceptors) and plays an important role in the regulation of blood circulation. The cervical segment includes part of the artery from the sinus to the entrance to the skull. Both of these segments do not give branches. In the extracranial section, the internal carotid artery is exposed to a greater extent than in other sections to the effects of various damaging factors, such as mechanical trauma or compression from the outside.

Features of atherosclerotic lesions of the main vessels of the head

Atherosclerosis of the extracranial segments of the main arteries of the head is a common pathology that requires high-quality and timely treatment. Lack of therapy can lead to ischemic stroke. This form of the disease is chronic and manifests itself in the defeat of the vascular system of the brain through the formation of growths. As the disease progresses, the gaps narrow.

General characteristics of the disease

As a result of atherosclerotic lesions of the vessels, their inner walls become denser, which provokes a number of complications. The quality of life of patients deteriorates significantly, blood circulation is disturbed, cells do not receive enough oxygen and nutrients.

In the initial stages, the disease proceeds without visible symptoms, so it is very difficult to detect and diagnose the disease under such circumstances. When cholesterol plaques do not cover more than fifty percent of the lumen, then this stage is characteristic of atherosclerosis of the main arteries of the head of a non-stenosing type.

As the pathological process develops, the signs manifest themselves in the form of impaired auditory and visual functions. People often complain of headaches, tinnitus, pointing to "flies" that appear before their eyes, a feeling of numbness in the legs and arms. In most cases, these manifestations are very weak, so usually people do not pay attention to them. Detection of pathology at this stage is possible only during a random examination.

Clinical manifestations become distinct already with the progression of stenosing atherosclerosis of the main arteries of the head.

The walls of the vascular lumens are narrowed by more than fifty percent. One of the main reasons for its occurrence is old age. At the same time, there are several risk factors that can lead to the development of pathology. This form becomes chronic. It is much more dangerous and causes serious complications.

The reasons

Atherosclerosis of the main vessels of the brain occurs due to various reasons. To date, the etiology of the disease is still being studied. But any pathological processes associated with a violation of the breakdown and production of fats are the result of complications of lipid metabolism in the body. More often, people with overweight problems are prone to the occurrence of such diseases.

Other factors contributing to the development of the disease include:

1. Bad habits. To reduce the risk of developing pathology, it is necessary to get rid of smoking and excessive consumption of alcoholic beverages.
2. Systematic increase in blood pressure.
3. The presence of diabetes.
4. Bad nutrition.
5. hereditary predisposition.
6. Sedentary lifestyle.
7. Overweight problems, obesity of varying degrees.
8. High cholesterol.
9. Endocrine diseases.

Damage to the main arteries of the head develops against the background of constant exposure to stressful situations, age-related changes (according to statistics, males are more susceptible to pathology). It should also be taken into account that atherosclerosis of the extracranial segments of the MAH is diagnosed more often than damage to the intracranial vessels.

The walls of the main systems are thinner in structure, their level of elasticity is slightly lower. This creates fertile ground for the development of stenosis in comparison with the vascular systems of other organs.

Clinical manifestations of the disease

Memory impairment is the most characteristic symptom of the stenotic form of pathology. The gradual deterioration of the condition is accompanied by headaches spreading to the neck area, and dizziness, which is caused by insufficient supply of oxygen and nutrients. Pain syndrome can intensify against the background of constant overwork and stress. After some time, the pain worsens, and this condition becomes habitual for the patient. Other clinical manifestations include:

• deterioration of visual and auditory functions (points, “flies” before the eyes, tinnitus);
• increased sweating;
• sleep problems, insomnia;
• incoordination, lameness;
• feeling of constant fatigue, weakness and drowsiness.

Negative changes also occur on the psycho-emotional background. Irritability appears, it becomes difficult for a person to concentrate, depressive disorders may appear. The manifestation of signs of the disease depends on the degree of damage to the vascular system and malnutrition of the brain cells.

It should be taken into account the fact that the gradual blockage of the internal gaps practically does not manifest itself in any way. Therefore, in the initial stages, a person is inclined to explain all the symptoms by fatigue, the presence of constant stress, and a busy work schedule. Usually the signs become more distinct in the afternoon, but their intensity decreases sharply after rest.

As the disease progresses, the symptoms get worse. They are also accompanied by impaired speech, trembling of the upper limbs. People experience some difficulty in eating (hard to swallow), the first signs of depression appear.

At the stage of decompensation in patients, memory deteriorates significantly, the ability to soberly assess what is happening around is lost. During this period, there is a high risk of developing serious complications (paralysis or stroke).

With transient ischemic attacks, a person feels as if the upper or lower limbs do not obey him. The clinical manifestations of this condition directly depend on the area of ​​the affected area.

Diagnostics

The process of making a diagnosis begins with a study of the patient's history and initial examination. To determine the level of cholesterol, the doctor prescribes a biochemical blood test, evaluates the KLA and OAM. To identify the lesion, a series of instrumental manipulations is carried out.

To establish the stage of the disease, you will need an ultrasound examination of the extracranial and intracranial vessels of the brain. Systolic murmurs of stenotic arteries are performed using duplex scanning.

In order to definitively confirm the diagnosis, an MRI may be needed, as well as angiography of the vascular system. This method evaluates the condition of seals on the walls.

Features and specifics of treatment

For the treatment of pathology that affects the vascular system of the brain, complex therapy is used. This process largely depends on the efforts of the patients themselves. Doctors strongly recommend a radical change in lifestyle: get rid of bad habits, eat right (first of all, this is the rejection of spicy, fried and fatty foods high in cholesterol), engage in moderate physical activity.

Drug therapy is usually based on taking the following drugs:

1. Antiplatelet agents, the action of which is aimed at thinning the blood.
2. Statins. Prevent growth in size.
3. Fibratov. They help lower triglyceride levels.
4. nicotinic acid.
5. Vitamin complexes.
6. Antihypertensive drugs. Normalize blood pressure, but only if taken daily. Otherwise, the patient is threatened with the development of a hypertensive crisis.
7. Ezetimibov. They do not allow cholesterol to be actively absorbed in the intestine.

In some cases, surgery may be needed. With the help of open surgery, the growth is removed. This method is known as an endarterectomy. To provide access to the affected area, the skin is cut, the blood flow is blocked and the vascular wall is cut. After the growth is removed.

Using the endoscopic method, an endoscope is inserted into large vessels, and then the lumen is expanded with stents. Thus, normal blood circulation is restored.

Possible complications and prevention of the disease

A pathological change in the vessels leads to oxygen starvation, which provokes tissue atrophy. Against this background, mental and emotional disorders develop.

As the disease progresses, there is a systematic increase in blood flow pressure. The walls are very thinned, their former elasticity is lost. The lack of timely treatment leads to an even greater growth of growths, which ultimately can provoke a hypertensive crisis, and then a stroke.

Prevention measures include regular examination by a doctor and determining the level of cholesterol in the blood. You should also perform systematic but moderate exercise, eat right and minimize exposure to stress factors.

Pathogenesis of atherosclerosis of the main arteries of the brain

There are various diseases of the circulatory system. The most common is atherosclerosis of the main arteries of the brain. This disease is chronic and is expressed in damage to the vessels of the brain, the formation of atherosclerotic plaques in them, narrowing of the lumen of the vessels and the appearance of hemodiscirculatory processes.

In this article, we will look at the causes of this disease, symptoms, treatment and diagnosis.

Causes of atherosclerosis

The causes of atherosclerosis of the main vessels of the brain can be varied. However, for all lipid deposits, regardless of where exactly the atherosclerotic plaque is located, there are the following provoking factors:

• The level of arterial pressure is increased and observed for a long period of time;
• Smoking and alcohol. Since they are another factor that provokes abnormal blood pressure;
• Elevated blood cholesterol levels;
• Obesity of any degree and bad eating habits;
• Diseases of the endocrine system;
• Diabetes;
• Diseases of the cardiovascular system;
• Lack of physical activity and a sedentary lifestyle;
• Frequent presence of the body in a state of stress;
• Age-related changes (in men after 40 years, in women - after 50).

Pathogenesis of atherosclerosis of the main arteries

Atherosclerosis of the extracranial segments of the main arteries of the head occurs several times more often than atherosclerosis of the intracranial vessels of the brain.

atherosclerosis mag. arteries has its own qualities and differences in view of certain structural features of the arteries of the brain:

• The walls of the main arteries of the brain are much thinner than the walls of the vessels of other organs. Due to this, atherosclerosis develops faster and has a more extensive damage to areas over a certain time, in comparison with other vessels of the organs;
• The walls of the arteries of this department do not have a muscular-elastic layer;
• In the main section, the elastic membrane is well developed, which contains a high content of smooth muscle and elastic fibers.

There are also certain features of atherosclerotic plaques, which are formed in the main parts of the brain:

• Atherosclerosis of the carotid arteries at the extracranial level forms plaques that are more fibrous and stenotic in structure, and also unstable in relation to plaques formed in other arteries;
• Plaques located in the main arteries have much more collagen and much less lipids than plaques in other departments;
• Carotid plaques have a large number of unequal parts in the structure (heterogeneity).

Ways of damage to atherosclerotic plaques in the main arteries

• Rupture of lipid-rich plaques. Leads to arterial embolism, atherothrombotic strokes and the development of coronary heart disease;
• Damage to plaques followed by hematomas or opening (dissection). Most often associated with systolic blood strokes.

Symptoms

Atherosclerosis of the main arteries of the head has the following accompanying symptoms:

• There is a headache, as well as frequent cases of dizziness. Headache can come in attacks, and it occurs regardless of the time of day. Dizziness has a different intensity - from mild to severe fainting (depending on the degree of the disease);
• Noise in ears;
• Insomnia, frequent awakenings in the middle of the night, rapid fatigue and a feeling of drowsiness throughout the day;
• Atherosclerosis of the main arteries of the head at the extracranial level can also manifest itself in a decrease in short-term memory;
• Emotional instability, which manifests itself in tearfulness, passivity, constant anxiety and suspicion;
• Neurological disorders that are characterized by impaired speech, behavior and gait.

Diagnosis of atherosclerosis

It is impossible to diagnose the main atherosclerosis at home, you must consult a doctor. The attending physician will determine the location and degree of damage to the arteries, the nature and severity of the atherosclerotic plaque, the level of connective tissue growth, the level of cholesterol in the blood, etc.

Diagnosis begins with a general examination of the patient and anamnesis, after which the patient is sent for tests and ultrasound of the brain. In order for the picture with atherosclerosis of the extracranial arteries to be more accurate, the doctor may prescribe additional studies - an x-ray of the brain and an MRI.

Treatment

You have identified and determined that this is atherosclerosis of the main vessels of the brain, then long-term treatment will follow. It is necessary to carry out an improvement in the state of health in a complex way, some medications that the doctor prescribed will not be enough.

In order to get rid of this disease, you need to change some habits and change your lifestyle, namely:

• Lead a more active and mobile lifestyle:
• Refuse junk food high in fat;
• Quit smoking/drinking alcohol;
• Go on a diet that will contain a lot of vegetables, fruits, cereals, lean meats and fish.

As a drug treatment, the following drugs are usually prescribed:

• Antiaggregant-containing agents - Plavix, cardiomagnyl, etc.;
• Drugs that are aimed at thinning the blood - sulodexide, etc.;
• Means that improve peripheral circulation. The best drug in this category is nicotinic acid;
• Drugs aimed at strengthening and improving collateral circulation - alcovegin, solcoseryl;
• Medicines that help lower blood cholesterol levels - nicotinic acid, Crestor;
• Analgesics may also be prescribed to help relieve pain.

The list of drugs does not end there and varies depending on the degree and characteristics of the lesion. They may also prescribe acetylsalicylic acid (reduces the risk of blood clots), which will need to be taken throughout life.

Recovery is not limited to drugs; surgery may also be prescribed. For example, if an atherosclerotic plaque has reduced the lumen of the arteries by half, then the patient is consulted and surgical intervention is prescribed.

Features of atherosclerosis MAG (main arteries of the head)

According to the latest sad statistics, more and more people are being diagnosed with atherosclerosis. If earlier this disease was considered age-related, now it is rapidly getting younger. Its most dangerous variety is stenosing atherosclerosis of the MAG (main arteries of the head). The problem is associated with the deposition of cholesterol plaques in the blood vessels of the brain, neck and large arteries of the lower extremities. The disease is chronic and it is impossible to completely get rid of it. But measures can be taken to stop its rapid development. To do this, you need to remember the peculiarity of the course of the disease and the main therapeutic methods.

Features of atherosclerosis of the main vessels

The development of atherosclerosis is associated with the deposition of fat cells on the walls of the arteries. At the beginning, the clusters are small and do not cause serious harm. If measures are not taken in time, then the plaques grow significantly and block the lumen of the vessels. As a result, blood circulation deteriorates.

Atherosclerosis of the main arteries of the head is a serious danger to humans. As the disease progresses, there is a blockage of the vessels of the neck and head, which are responsible for the full blood supply to the brain.

A severe form of the disease may be accompanied by the destruction of the vessel wall and the formation of an aneurysm. Thromboembolism can aggravate the situation. The rupture of such an aneurysm is fraught with serious health consequences, including death.

Depending on the severity of the disease, there are two main varieties:

1. non-stenosing atherosclerosis. This term refers to a condition in which the plaque covers no more than 50% of the lumen of the vessel. This form is considered the least dangerous to human life and health.
2. stenosing atherosclerosis. With this course of the disease, the vessel is blocked by a plaque by more than half. This greatly impairs the blood supply to the internal organs.

The sooner the disease is diagnosed, the greater the chance of successful treatment. It is almost impossible to completely get rid of the disease, so each person needs to take measures to eliminate the factors that provoke atherosclerosis.

What factors cause the onset of the disease?

In order for the treatment of atherosclerosis of MAH to be successful, it is necessary to identify and eliminate the cause of its occurrence. Among them are:

1. Increased blood pressure.
2. An excess of cholesterol in the blood.
3. Diseases of the endocrine system.
4. Excessive drinking and smoking.
5. Problems with the absorption of glucose.
6. Lack of physical activity.
7. Adherence to malnutrition.
8. Age-related changes in the body.
9. Prolonged exposure to stressful situations.
10. Overweight.

Most often, the disease affects older men. It is especially important for them to control the state of their health, adhere to the correct principles of competent nutrition and lifestyle.

Each person periodically needs to control the level of blood pressure and cholesterol in the blood. A timely medical examination will help in this.

Symptoms of atherosclerosis

Atherosclerosis of extracranial arteries is manifested by vivid symptoms. It will largely depend on the localization of plaques. If the lesion occurs in the vessels of the brain, then the following symptoms appear:

1. The appearance of noise in the ears.
2. Intense headaches and dizziness.
3. Memory problems.
4. Discoordination of movements, impaired speech. Other neurological abnormalities may also be present.
5. Sleep problems. A person falls asleep for a long time, often wakes up in the middle of the night, during the day he is tormented by drowsiness.
6. Change in the psyche. There is increased irritability, anxiety of a person, he becomes whiny and suspicious.

Atherosclerotic lesions can also be localized in the arteries of the extremities. In this case, the symptoms will be different. The following signs of the disease appear:

1. Decreased pulsation in the lower extremities.
2. Rapid fatigue during physical exertion. This is especially pronounced when walking long distances.
3. Hands become cold. Small sores may appear on them.
4. In severe cases, gangrene develops.
5. If the vessels of the lower extremities are affected, then the person begins to limp.
6. The nail plates become thinner.
7. There is hair loss on the lower extremities.

Symptoms of atherosclerosis MAH can have varying degrees of severity. At the initial stage, it is possible to identify the problem only during a medical examination.

If you find the first signs of the disease, you should immediately consult a doctor. Only under the condition of a timely diagnosis will it be possible to stop the development of the disease.

Making an accurate diagnosis

It is possible to identify the defeat of the main arteries of the head only during a full medical examination. Specialists need to determine the localization of the problem, the parameters of the formed plaque, as well as the presence of proliferation of connective tissue.

The following diagnostic methods are used:

1. General and biochemical blood tests.
2. Ultrasound procedure. An examination of the vascular system, which is responsible for the blood supply to the brain, is carried out. The carotid and vertebral arteries are examined. The specialist determines their condition, diameter, change in lumen.
3. Magnetic resonance imaging. This is a survey that allows you to study in great detail the structure of the arteries of the brain, neck, limbs. Modern equipment guarantees taking pictures in various projections. This technique is considered the most informative.
4. Angiography. Allows you to study all the pathologies of the vascular system. A specialized contrast agent is injected into the patient's blood. This is followed by an X-ray examination.

The specific method of examination is chosen by the doctor individually for each patient. This takes into account the characteristics of the body, as well as the equipment that the medical institution has.

How is the therapy carried out?

Non-stenosing atherosclerosis in the early stages is treatable. With an integrated approach and strict observance of all the prescriptions of a specialist, it is possible to restrain the development of the disease.

The following methods are currently the most effective:

1. Medical treatment. It involves taking specialized medications.
2. Surgical intervention. This procedure is associated with a risk to the life and health of the patient. It is used only in severe cases, when all other methods of treatment are ineffective. Non-stenosing atherosclerosis is not surgically treated.
3. Lifestyle adjustment. To stop the development of the disease, it is necessary to give up bad habits, especially smoking. You should minimize the consumption of fatty, fried, smoked foods. You need to move more, go in for sports, enroll in the pool. In this case, the load should be moderate. It is best to consult with a specialist.
4. Diet food. Experts recommend adhering to special dietary rules. This will help reduce the amount of cholesterol entering the body.
5. exercise therapy. There is a specialized set of exercises that helps restore normal blood supply to all segments of the brain and limbs.
6. Health monitoring. It is necessary to regularly measure blood pressure, monitor the concentration of cholesterol in the blood. All comorbidities should be treated promptly.

Successful treatment is possible only if all negative factors are eliminated. The patient should avoid stressful situations, eat right and walk more in the fresh air. At the same time, it is imperative to strictly follow all the recommendations of the doctor.

What medicines are used for therapy

Today, several groups of drugs have been developed that have a positive effect in the treatment of atherosclerosis of the main vessels of the brain:

1. Antiplatelet agents. Drugs of this type prevent blood platelets from sticking together, which reduces the risk of developing thrombosis. Such funds are prohibited for use in renal and hepatic insufficiency, pregnancy, peptic ulcer and hemorrhagic stroke. The most popular drugs in this group are Trombo-ass, Cardiomagnyl, Plavix and so on.
2. Drugs that reduce blood viscosity. They help blood flow better through narrowed places. These include Sulodexide. Phlogenzym and others.
3. Preparations based on nicotinic acid. They are designed to improve circulation.
4. Medications that lower the concentration of cholesterol in the blood. With their help, non-stenosing atherosclerosis can be effectively treated. Among them are Crestor, Torvacard and others.
5. Means to enhance collateral circulation. This group includes Solcoseryl, Actovegin and some others.
6. Drugs to relieve symptoms. It can be anti-inflammatory and analgesics.

Drug therapy will take at least two to three months. Specific dosage and duration of therapy is determined by a specialist for each patient.

Patients suffering from atherosclerosis of the arteries of the brain are shown a life-long intake of acetylsalicylic acid. These drugs will help minimize the risk of developing thrombosis.

Treatment with surgical methods

Cerebral atherosclerosis in severe cases is treated with surgical intervention. This technique is used in the stenosing type of the disease. There are three main ways to carry out the operation:

1. Shunting. During this operation, the surgeon creates an additional blood flow near the damaged area. Thus, it is possible to restore normal blood flow.
2. Stenting. This operation involves the installation of a special implant, with which it is possible to restore normal blood flow.
3. Balloon angioplasty. The procedure involves the introduction of a specialized cartridge into the vessel. Pressure is applied to it, which expands the affected vessel.

A specific technique is chosen by a specialist based on the patient's state of health, as well as in which of the segments of the vascular system the lesion is localized.

Physiotherapy

Non-stenosing atherosclerosis responds well to treatment if the main therapy program is supplemented with physiotherapy exercises. It is best to conduct a lesson with a specialist.

But some exercises can be performed independently:

1. Walk with measured steps around the room. At the same time, make sure that your blood pressure does not rise.
2. Stand up straight. Exhale slowly and tilt your head back. At the same time, try to bend the cervical spine as much as possible. Hold this position for a couple of seconds. After that, slowly return to the starting position. Repeat the same procedure with the head tilted forward.
3. Stand up and straighten your spine as much as possible. Place your hands on your chest. On the count of one, raise your hands up, stretch to the ceiling. On the count of two, return to the starting position. Repeat this exercise 12 times.
4. Stand up straight. Make slow tilts of the body to the left and right sides. Make sure that the slope is made on the exhale, and return to the starting point on the inhale.
5. Sit in a high back chair. Try to relax. On the count of one, take one leg out to the side. Return to the original pose. Repeat the same steps with the other leg.

By repeating these exercises regularly, you can alleviate the course of the disease. They allow you to stimulate blood circulation and increase the tone of the vascular wall.

Folk methods of treatment

You can supplement the main therapy program with the help of traditional medicine. They cannot act as the only way of therapy.

Among the most effective recipes against atherosclerosis are:

1. Dilute a teaspoon of birch buds in a glass of boiling water. Boil the resulting composition for 25 minutes. After that, leave the product for a couple of hours to infuse. Take the prepared composition three times a day in an amount of 100 ml.
2. Pour a teaspoon of dried hawthorn flowers into a glass of water. This composition must be boiled for about 25 minutes. After that, it can be filtered. Wait until the broth cools down. It is taken in half a glass three times a day.
3. Squeeze the juice from one onion. Combine it with natural honey. One spoonful of honey is needed for one spoonful of juice. Add some water to make the composition liquid. It is necessary to take such a remedy one spoonful three times a day.

Such simple remedies will help enhance the effectiveness of traditional treatment. Sometimes they can provoke allergic reactions, so you should consult your doctor before using them.

Dietary diet

During treatment, patients with atherosclerosis are shown to follow a special diet. This is the only way to reduce the amount of cholesterol in the blood. You must adhere to the following recommendations:

1. The use of foods enriched with iodine, such as seaweed, is recommended.
2. A complete rejection of animal fats is shown. The lack of protein can be filled with legumes.
3. Eat more diuretic foods. These include watermelons, apples, melons and others.
4. The diet should include more vegetables, fruits, nuts, berries.
5. Chicken and turkey are allowed. Fatty meats, as well as offal are strictly prohibited.
6. You will have to give up sweets, coffee, strong tea, chocolate, canned foods.

Compliance with the principles of proper nutrition will help to stop the development of the disease and enhance the effect of medicines. At the first manifestations of atherosclerosis, you should immediately seek help from a specialist. The sooner a problem is identified, the greater the likelihood of maintaining health.

All information on the site is provided for informational purposes only. In case of symptoms of the disease, contact a specialist.

Abdominal aorta and its branches. Normally, the aorta has a regular rounded shape and its diameter at the level of the navel is 2 cm. In asthenics, the aortic bifurcation is located at a distance of 2-3 cm from the skin surface. An increase in the size of the aorta at the diaphragm and at the level of the visceral branches up to 3 cm, above the bifurcation up to 2.5 cm is regarded as a pathological expansion, up to 4.0 cm at the diaphragm and at the level of the visceral branches and up to 3.5 cm at the bifurcation - an emerging aneurysm, more than 4.0 cm at the diaphragm and at the level of visceral branches and more than 3.5 cm at the bifurcation - as an aortic aneurysm. Biometry of the celiac trunk, common hepatic and splenic arteries is carried out in the longitudinal and transverse planes. The celiac trunk departs from the aorta at an angle of 30-40 degrees, its length is 15-20 mm. In the longitudinal plane, the angle between the superior mesenteric artery and the aorta is 14 degrees, but with age it increases to 75-90 degrees.

Inferior vena cava and its tributaries. According to most authors, the size of the inferior vena cava is variable and depends on the heart rate and respiration. Normally, according to L.K. Sokolov et al., the anteroposterior size of the vein is 1.4 cm, but can reach 2.5 cm. during a study or Valsalva test. A stable diameter of the vein and its branches should be regarded as a sign of venous hypertension in heart disease, right ventricular failure, thrombosis or narrowing of the inferior vena cava at the level of the liver, etc.

Normally, in most healthy individuals, according to D. Cosgrove et al., all 3 hepatic veins are visualized: middle, right and left, but in 8% of cases one of the main veins may not be determined. The diameter of the hepatic veins at a distance of 2 cm from the place of confluence with the inferior vena cava is normally 6-10 mm, with venous hypertension it increases to 1 cm or more. In addition to the main veins, in 6% of cases, the right inferior hepatic vein is determined, which directly flows into the inferior vena cava, its diameter ranges from 2 to 4 mm.

The size of the renal veins is variable. In pathological conditions, such as thrombosis, their diameter increases to 8 mm-4 cm. B. Kurtz et al. note that the unpaired and semi-unpaired veins are located along the aorta and look like echo-negative rounded formations, the diameter of which is 4-5 mm.

Portal vein and its branches. Portal vein biometry is of great differential diagnostic value in recognizing a number of diseases of the liver, spleen, congenital or acquired anomalies, in assessing the effectiveness of porto-caval and renal anastomoses, etc. Normally, the portal vein crosses the inferior vena cava at an angle of 45 degrees and at this level has a diameter from 0.9 to 1.3 cm. Other authors believe that this figure can increase to 1.5 - 2.5 cm. The right branch of the portal vein is wider than the left, respectively, 8.5 and 8 mm, however, the segmental branches of the left lobe are larger right, 7.7 and 5.4 mm. The cross-sectional area of ​​the portal vein is normally 0.85±0.28 cm2. With cirrhosis of the liver, the diameter of the portal vein increases to 1.5-2.6 cm, and the cross-sectional area - up to 1.2 ± 0.43 cm2. In recent years, dopplerography of the portal vein and its branches has become of great importance in the diagnosis of portal blood flow disorders. Normally, the blood flow velocity ranges from 624 to 952 ± 273 ml/min, and after a meal it increases by 50% of the level outcome. Careful biometry of the splenic and mesenteric veins is important for diagnosing chronic pancreatitis, portal hypertension, assessing the effectiveness of porto-caval anastomoses, etc. According to some authors, the diameter of the vein ranges from 4.2 to 6.2 mm and averages 4.9 mm, others believe that it can reach 0.9-1 cm. Expansion of the vein up to 2 cm or more is undoubtedly a sign of venous hypertension.

There are several types of vessels:

Trunk- the largest arteries in which the rhythmically pulsating blood flow turns into a more uniform and smooth one. The walls of these vessels contain few smooth muscle elements and many elastic fibers.

Resistive(resistance vessels) - include precapillary (small arteries, arterioles) and postcapillary (venules and small veins) resistance vessels. The ratio between the tone of pre- and post-capillary vessels determines the level of hydrostatic pressure in the capillaries, the magnitude of the filtration pressure and the intensity of fluid exchange.

true capillaries(exchange vessels) - the most important department of the CCC. Through the thin walls of the capillaries there is an exchange between blood and tissues.

capacitive vessels- venous department of the CCC. They contain about 70-80% of all blood.

Shunt vessels- arteriovenous anastomoses, providing a direct connection between small arteries and veins, bypassing the capillary bed.

Basic hemodynamic law: the amount of blood flowing per unit time through the circulatory system is the greater, the greater the pressure difference in its arterial and venous ends and the lower the resistance to blood flow.

During systole, the heart ejects certain portions of blood into the vessels. During diastole, blood moves through the vessels due to potential energy. The stroke volume of the heart stretches the elastic and muscular elements of the wall, mainly the main vessels. During diastole, the elastic wall of the arteries collapses and the potential energy of the heart accumulated in it moves the blood.

The value of the elasticity of the vascular walls consists in the fact that they provide the transition of intermittent, pulsating (as a result of contraction of the ventricles) blood flow into a constant one. This smooths out sharp fluctuations in pressure, which contributes to the uninterrupted supply of organs and tissues.

Blood pressure is the pressure of blood on the walls of blood vessels. Measured in mmHg.

The value of blood pressure depends on three main factors: frequency, strength of heart contractions, the value of peripheral resistance, that is, the tone of the walls of blood vessels.

Distinguish:

systolic(maximum) pressure - reflects the state of the myocardium of the left ventricle. It is 100-120 mm Hg.

diastolic(minimum) pressure - characterizes the degree of tone of the arterial walls. It equals 60-80 mm Hg.

Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is necessary to open the valves of the aorta and pulmonary trunk during ventricular systole. Normally, it is 35-55 mm Hg.

Average dynamic pressure equals the sum of diastolic pressure and 1/3 of the pulse pressure.

Increase in blood pressure hypertension, decrease - hypotension.

arterial pulse.

arterial pulse- periodic expansion and lengthening of the walls of the arteries, due to the flow of blood into the aorta during left ventricular systole.

The pulse is characterized by the following features: frequency- the number of strokes in 1 minute, rhythm- the correct alternation of pulse beats, filling- the degree of change in the volume of the artery, set by the strength of the pulse beat, voltage- is characterized by the force that must be applied to squeeze the artery until the pulse disappears completely.

The curve obtained by recording the pulse oscillations of the artery wall is called sphygmogram.

Features of blood flow in the veins.

The blood pressure in the veins is low. If at the beginning of the arterial bed the blood pressure is 140 mm Hg, then in the venules it is 10-15 mm Hg.

The movement of blood through the veins is facilitated by a number of factors:

• The work of the heart creates a difference in blood pressure in the arterial system and the right atrium. This ensures the venous return of blood to the heart.
• Presence in the veins valves promotes the movement of blood in one direction - to the heart.
• The alternation of contractions and relaxations of skeletal muscles is an important factor in facilitating the movement of blood through the veins. When the muscles contract, the thin walls of the veins are compressed, and the blood moves towards the heart. Relaxation of the skeletal muscles promotes the flow of blood from the arterial system into the veins. This pumping action of the muscles is called muscle pump, which is an assistant to the main pump - the heart.
• Negative intrathoracic pressure, especially in the inspiratory phase, promotes venous return of blood to the heart.

Blood circulation time.

This is the time required for the passage of blood through the two circles of blood circulation. In an adult healthy person with 70-80 heart contractions in 1 min, the complete blood circulation occurs in 20-23 s. Of this time, 1/5 falls on the pulmonary circulation and 4/5 on the large.

The movement of blood in various parts of the circulatory system is characterized by two indicators:

- Volumetric blood flow velocity(the amount of blood flowing per unit time) is the same in the cross section of any part of the CCC. The volumetric velocity in the aorta is equal to the amount of blood ejected by the heart per unit time, that is, the minute volume of blood.

The volumetric blood flow velocity is influenced primarily by the pressure difference in the arterial and venous systems and vascular resistance. The value of vascular resistance is influenced by a number of factors: the radius of the vessels, their length, blood viscosity.

Linear blood flow velocity is the path traveled per unit of time by each particle of blood. The linear velocity of blood flow is not the same in different vascular areas. The linear velocity of blood in veins is less than in arteries. This is due to the fact that the lumen of the veins is larger than the lumen of the arterial bed. The linear velocity of blood flow is the highest in the arteries and the lowest in the capillaries. Consequently , the linear velocity of blood flow is inversely proportional to the total cross-sectional area of ​​the vessels.

The amount of blood flow in individual organs depends on the blood supply to the organ and the level of its activity.

Physiology of microcirculation.

Contribute to the normal course of metabolism processes microcirculation- directed movement of body fluids: blood, lymph, tissue and cerebrospinal fluids and secretions of the endocrine glands. The set of structures that provide this movement is called microvasculature. The main structural and functional units of the microvasculature are the blood and lymphatic capillaries, which, together with the tissues surrounding them, form three links microvasculature Key words: capillary circulation, lymphatic circulation and tissue transport.

The total number of capillaries in the system of vessels of the systemic circulation is about 2 billion, their length is 8000 km, the area of ​​​​the inner surface is 25 sq.m.

The wall of the capillary is from two layers: internal endothelial and external, called basement membrane.

Blood capillaries and adjacent cells are structural elements histohematic barriers between blood and surrounding tissues of all internal organs without exception. These barriers regulate the flow of nutrients, plastic and biologically active substances from the blood into the tissues, carry out the outflow of cellular metabolic products, thus contributing to the preservation of organ and cellular homeostasis, and, finally, prevent the entry of foreign and toxic substances, toxins, microorganisms from the blood into the tissues, some medicinal substances.

transcapillary exchange. The most important function of histohematic barriers is transcapillary exchange. The movement of fluid through the capillary wall occurs due to the difference in the hydrostatic pressure of the blood and the hydrostatic pressure of the surrounding tissues, as well as under the influence of the difference in the osmo-oncotic pressure of the blood and intercellular fluid.

tissue transport. The capillary wall is morphologically and functionally closely related to the loose connective tissue surrounding it. The latter transfers the liquid coming from the lumen of the capillary with substances dissolved in it and oxygen to the rest of the tissue structures.

Lymph and lymph circulation.

The lymphatic system consists of capillaries, vessels, lymph nodes, thoracic and right lymphatic ducts, from which lymph enters the venous system.

In an adult in conditions of relative rest, about 1 ml of lymph flows from the thoracic duct into the subclavian vein every minute, from 1.2 to 1.6 l.

Lymph is a fluid found in the lymph nodes and blood vessels. The speed of movement of lymph through the lymphatic vessels is 0.4-0.5 m/s.

The chemical composition of lymph and blood plasma are very close. The main difference is that the lymph contains much less protein than the blood plasma.

Lymph formation.

The source of lymph is tissue fluid. Tissue fluid is formed from the blood in the capillaries. It fills the intercellular spaces of all tissues. Tissue fluid is an intermediate medium between blood and body cells. Through the tissue fluid, cells receive all the nutrients and oxygen necessary for their life activity, and metabolic products, including carbon dioxide, are released into it.

Lymph movement.

A constant flow of lymph is provided by the continuous formation of tissue fluid and its transition from the interstitial spaces to the lymphatic vessels.

Essential for the movement of lymph is the activity of organs and the contractility of the lymphatic vessels. In the lymphatic vessels there are muscle elements, due to which they have the ability to actively contract. The presence of valves in the lymphatic capillaries ensures the movement of lymph in one direction (to the thoracic and right lymphatic ducts).

Auxiliary factors contributing to the movement of lymph include: the contractile activity of striated and smooth muscles, negative pressure in large veins and the chest cavity, an increase in the volume of the chest during inspiration, which causes suction of lymph from the lymphatic vessels.

Main functions lymphatic capillaries are drainage, absorption, transport-eliminative, protective and phagocytosis.

Drainage function carried out in relation to the plasma filtrate with colloids, crystalloids and metabolites dissolved in it. The absorption of emulsions of fats, proteins and other colloids is carried out mainly by the lymphatic capillaries of the villi of the small intestine.

Transport-eliminative- this is the transfer of lymphocytes, microorganisms into the lymphatic ducts, as well as the removal of metabolites, toxins, cell debris, small foreign particles from the tissues.

Protective function The lymphatic system is carried out by a kind of biological and mechanical filters - lymph nodes.

Phagocytosis is to capture bacteria and foreign particles.

The lymph nodes.

Lymph in its movement from the capillaries to the central vessels and ducts passes through the lymph nodes. An adult has 500-1000 lymph nodes of various sizes - from the head of a pin to a small bean grain.

Lymph nodes perform a number of important functions: hematopoietic, immunopoietic, protective-filtration, exchange and reservoir. The lymphatic system as a whole ensures the outflow of lymph from the tissues and its entry into the vascular bed.