Embolism - treatment

Apr 7, 2012 , MUDr. Ján Podhorec

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embolie-lecba.jpg - kopie
By embolism we understand a sudden closure of a blood vessel, most often by a blood clot, which has torn off from the veins of the lower extremities. The best treatment of embolism is prevention of blood clots in the veins especially of the lower extremities. If, despite the precautions, embolism occurs, the treatment is pharmacological or surgical.

Treatment of embolism

Embolism is a condition where a foreign object is introduced in to the blood stream and obstructs a blood vessel. This can also include an adipose tissue, air bubble, or some object, which penetrated into the bloodstream from its surroundings. Most often a blood clot, technically a thrombus, forms in the blood vessel. Which blood vessel or artery will be closed by the thrombus, depends on the location where the thrombus forms. If it forms in the veins of the legs or pelvis, the thrombus migrates in to the pulmonary vessels and causes pulmonary embolism. But if it forms in the heart, it can get into virtually any artery of the body. This can lead to e.g. a stroke. Embolism is often a very serious and life-threatening acute condition that needs urgent treatment.

Types of embolism

Embolism is a life-threatening serious condition. Therefore, it is important to first determine the cause of the resulting condition. According to the character of the clotting, or embolus, we can distinguish several types of embolism.

  • The most common type of embolism is called thromboembolism, where the embolus is a blood clot that occurs mainly in the veins of the lower extremities and pelvis. It is dangerous because it can detach and be taken away by blood into the right side of the heart and the lungs, where due to its size, it can obstruct the pulmonary arteries. Blood clots can form also in the heart, if some parts do not contract properly, such as atrial fibrillation. Then, blood clots can tear off from the left atrium and by the left ventricle they are drifted into the systemic circulation. This blood clot can get into the brain and cause a stroke.
  • Another type is fat embolism, which is caused by bone injury, blunt trauma of adipose tissue, or burns. Fat particles are not visible by the naked eye and can get stuck in the capillaries in the brain or kidneys.
  • Air embolism occurs when air enters the peripheral veins, and it can due to physical laws prevent blood flow in the vessel. It can happen during operations when the air bubble gets into a peripheral vein through an introduced cannula. It also includes the so-called Caisson disease that is caused by rapid ascent during diving. Even small quantities of air can cause death.
  • Amniotic fluid embolism is caused by complications during childbirth. It is a result of ingestion of amniotic fluid into the venous system of the uterus during childbirth and it consequently enters the lungs by blood.
  • Foreign object embolism occurs when a foreign object enters the bloodstream. For example it can be a broken needle tip etc.

Symptoms of embolism

Symptoms of embolism are very various. In general, embolism of smaller embolus may be asymptomatic. But sometimes the consequences of embolism can be severe or even fatal. The symptoms mainly depend on the location of the embolus, i.e., whether it is in venous or arterial vessels.

  • If the embolus is carried by veins most likely it will get to the heart and from the heart directly to the lungs, where it will get stuck and cause pulmonary embolism. The symptoms are chest pain, shortness of breath, pallor, sweating, increased heart and respiratory rate and expectoration of blood. Lung function may be damaged to such an extent that it leads to death.
  • If the embolus is carried by arteries it may obstruct vessels in various organs, for example the brain and cause a stroke. Or it can block a blood vessel supplying oxygenated blood for the kidneys or intestines and cause a heart attack. An embolus may also prevent blood flow into a limb, causing its necrosis.

Risk factors of embolism

There are various risk factors that lead to embolism. The most vulnerable groups are immobile patients, then patients after surgery, especially of the legs. Also, vulnerable to embolism are patients with heart failure. A risk factor is the use of hormonal contraception.

Treatment of embolism

It is necessary to start the treatment of embolism as soon as possible since it can be a life-threatening condition. In principle, we can choose between pharmacological and surgical treatment of embolism. The most important treatment is, however embolism prevention, i.e. prevention of this disease.

Prevention of embolism

Many patients, who are treated for other disorders, are prone to embolism. Embolism may occur as a feared complication after major surgery or for long-term bedridden patients. It may also complicate other diseases, such as atrial fibrillation, a type of abnormal heart rhythm. It is evident that a consistent treatment of the main disease is primary. But since this is a condition with a tendency to form blood clots, medications that reduce this unwanted process are administrated. Administration of such drugs is, however, only preventive.

Pharmacological treatment of embolism

Pharmacological treatment of embolism is administration of medication. Sometimes it happens that all preventive measures will not prevent embolism. Additionally embolism can occur unexpectedly and be the first symptom of another disease. Although it can happen that it will go unnoticed, but often it is a serious condition requiring prompt treatment. Perhaps the most common is the use of medications that are administrated intravenously in the form of infusion, subcutaneously and later in the form of tablets and their role is to reduce blood clotting. These are the so-called anticoagulants and their known representatives are Heparin, or Warfarin. This treatment is usually sufficient. In some cases it is better to use drugs based on a different mechanism, which directly dissolve the problematic blood clot. They are called thrombolytic agents. However, there are patients whom are not good candidates for this treatment due to their health. For them, the solution is surgery.

Surgical treatment of embolism

Surgical treatment of embolism is embolectomy. It is a surgical procedure in which a blood clot is removed through the Fogarty catheter. The advantage of this procedure is that it can be performed under local anesthesia. If there is a risk that new blood clots are formed, a so-called inferior vena cava filter is introduced. It has the shape of a small mesh basket, which is inserted into the inferior vena cava. This filter is introduced by endovascular surgery, which requires venipuncture, introduction of the catheter with a filter to the destination, where it opens. Inferior vena cava filter is able to capture emboli of different sizes and thus prevent pulmonary embolism.

Long-term treatment of embolism

After successful acute treatment usually long-term treatment is required, this is mostly preventive and also lifelong. It is necessary to follow the specified treatment, and as well carry out regular checks. Of course it is also necessary to adapt your lifestyle and contribute to reducing the risk of new embolism. One of the most important measures is to stop smoking, since this habit damages the blood vessels, thus significantly contributing to the formation of blood clots. Even though the treatment of embolism is on a high level in our country, still pulmonary embolism and stroke are a very common cause of death.

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