CareWorks Health Services
Moulton Parkway STE 103C
Laguna Hills, CA 92653
arterial ischemic disorder
and external resources
ischemia of the toes with characteristic cyanosis.
ischemia, also spelled as ischaemia or ischæmia,
is a restriction in blood supply to tissues,
causing a shortage of oxygen
needed for cellular
metabolism (to keep tissue alive).
Ischemia is generally caused by problems with blood
vessels, with resultant damage to or dysfunction of
tissue. It also means local anemia
in a given part of a body sometimes resulting from congestion
(such as vasoconstriction,
oxygen is carried to tissues in the blood,
insufficient blood supply causes tissue to become starved
of oxygen. In the highly aerobic
tissues of the heart
and brain, irreversible
damage to tissues can occur in as little as 3–4 minutes
at body temperature. The kidneys
are also quickly damaged by loss of blood flow. Tissues
with slower metabolic rates may undergo irreversible damage
after 20 minutes.
manifestations of acute arterial ischemia include pain,
(the "six Ps")[citation
immediate intervention, ischemia may progress quickly to
within a few hours. Paralysis
is a very late sign of acute arterial ischemia and signals
the death of nerves
supplying the extremity. Foot
drop may occur as a result of nerve
damage. Because nerves are extremely sensitive to hypoxia,
or ischemic neuropathy
may persist after revascularization
and may be permanent.
ischemia may be asymptomatic or may cause chest pain, known
pectoris. It occurs when the heart muscle, or myocardium,
receives insufficient blood flow. This most frequently results
which is the long-term accumulation of cholesterol-rich
plaques in the coronary
heart disease is the most common cause of death in most
Western countries and a major cause of hospital admissions.
large and small bowel can be affected by ischemia. Ischemia
of the large
intestine may result in an inflammatory process known
colitis. Ischemia of the small bowel is called mesenteric
ischemia is insufficient blood flow to the brain,
and can be acute (i.e., rapid) or chronic (i.e., long-lasting).
stroke is a neurologic emergency that may be reversible
if treated rapidly. Chronic ischemia of the brain may result
in a form of dementia
dementia. A brief episode of ischemia affecting the
brain is called a transient
ischemic attack (TIA), frequently referred to as a mini-stroke.
of blood flow to a limb results in acute limb ischemia.
blood flow to the skin layers may result in mottling
or uneven, patchy discoloration of the skin
is a vascular
disease involving an interruption in the arterial blood
supply to a tissue,
or extremity that, if untreated, can lead to tissue death.
It can be caused by embolism,
of an atherosclerosis
artery, or trauma. Venous
problems like venous outflow obstruction and low-flow states
can cause acute
arterial ischemia. An aneurysm
is one of the most frequent causes of acute arterial ischemia.
Other causes are heart conditions including myocardial
valve disease, chronic atrial
in all of which thrombi
are prone to develop.
may dislodge and may travel anywhere in the circulatory
system, where they may lead to pulmonary
embolus, an acute arterial occlusion
causing the oxygen and blood
supply distal to the embolus
to decrease suddenly. The degree and extent of symptoms
depend on the size and location of the obstruction,
the occurrence of clot
fragmentation with embolism
to smaller vessels, and the degree of peripheral
arterial disease (PAD).
injury to an extremity may produce partial or total
occlusion of a vessel from compression,
Acute arterial occlusion may develop as a result of arterial
dissection in the carotid
artery or aorta
or as a result of iatrogenic
arterial injury (e.g., after angiography).
inadequate flow of blood to a part of the body may be caused
by any of the following:
results in tissue damage in a process known as ischemic
cascade. The damage is the result of the build-up of
waste products, inability to maintain cell
damage, and eventual leakage of autolyzing
into the cell and surrounding tissues.
of blood supply to ischemic tissues can cause additional
damage known as reperfusion
injury that can be more damaging than the initial ischemia.
Reintroduction of blood flow brings oxygen back to the tissues,
causing a greater production of free
radicals and reactive
oxygen species that damage cells. It also brings more
calcium ions to the tissues causing further calcium overloading
and can result in potentially fatal cardiac
arrhythmias and also accelerates cellular self-destruction.
The restored blood flow also exaggerates the inflammation
response of damaged tissues, causing white
blood cells to destroy damaged cells that may otherwise
still be viable.
treatment is essential to keep the affected limb viable.
The treatment options include injection of an anticoagulant,
surgical revascularisation, or amputation.
Anticoagulant therapy is initiated to prevent further enlargement
of the thrombus.
Continuous IV unfractionated
heparin has been the traditional agent of choice.
the condition of the ischemic limb is stabilized with anticoagulation,
may be treated with catheter-directed thrombolysis
using intraarterial infusion
of a thrombolytic
agent (e.g., recombinant tissue plasminogen activator (tPA),
A percutaneous catheter
inserted into the femoral
artery and threaded to the site of the clot
is used to infuse the drug. Unlike anticoagulants,
agents work directly to resolve the clot over a period of
24 to 48 hours.
may be necessary to remove the clot. Surgical revascularization
may be used in the setting of trauma (e.g., laceration of
the artery). Amputation
is reserved for cases where limb salvage is not possible.
If the patient continues to have a risk of further embolization
from some persistent source, such as chronic atrial
fibrillation, treatment includes long-term oral anticoagulation
to prevent further acute arterial ischemic episodes.
in body temperature reduces the aerobic metabolic rate of
the affected cells, reducing the immediate effects of hypoxia.
Reduction of body temperature also reduces the inflammation
response and reperfusion injury. For frostbite injuries,
limiting thawing and warming of tissues until warmer temperatures
can be sustained may reduce reperfusion injury.
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Anaheim 92801, 92802, 92803, 92804, 92805, 92806, 92807, 92808, 92809,
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Brea, 92821, 92822,92823,
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Corona del Mar, 92625,
Costa Mesa, 92626, 92627, 92628,
Dana Point, 92629,
East Irvine, 92650,
El Toro, 92609,
Foothill Ranch, 92610,
Fountain Valley, 92708, 92728,
Fullerton, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838,
Garden Grove, 92840, 92841, 92842, 92843 ,92844, 92845, 92846,
Huntington Beach , 92605, 92615, 92646, 92647, 92648, 92649,
Irvine, 92602, 92603, 92604, 92606, 92612, 92614, 92616, 92617, 92618,
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La Habra, 90631, 90632, 90633,
La Palma, 90623,
Ladera Ranch, 92694,
Laguna Beach , 92651, 92652,
Laguna Hills ,92653, 92654,92607,92677,
Laguna Woods, 92637,
Lake Forest, 92630,
Los Alamitos, 90720, 90721,
Midway City, 92655,
Mission Viejo, 92690, 92691, 92692,
Newport Beach , 92658, 92659, 92660, 92661, 92662, 92663, 92657,
Orange, 92856, 92857, 92859, 92862, 92863, 92864, 92865, 92866, 92867,
92868, 92869, Placentia, 92870, 92871,
Rancho Santa Margarita 92688,
San Clemente, 92672, 92673, 92674,
San Juan Capistrano, 92675, 92693,
Santa Ana , 92701, 92702, 92703, 92704, 92705 ,92706, 92707, 92711,
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Seal Beach , 90740,
Sunset Beach 90742,
Trabuco Canyon, 92678, 92679,
Tustin ,92780, 92781,92782,
Villa Park, 92861,
Westminster, 92683, 92684, 92685,
Yorba Linda, 92885, 92886, 92887