[The physiopathology and medical treatment of acute traumatic occlusion of the popliteal artery. The point of view of the anesthesiologist-resuscitator].
The acute occlusion of the popliteal artery involves: 1. A regional disease: muscular ischaemia with an increase of capillary permeability and oedema. The recovery of the circulation brings with it the formation of free radicals. 2. Sometimes, a general and metabolic illness complicates the muscular ischaemia. It associates to varying degrees: hypovolemic shock, metabolic troubles, acute renal failure, disseminated intravascular coagulation, infection. It can compromise the vital prognosis. The reanimation which completes the surgical treatment includes two stages: 1. The prehospital stage when the first imperative is to commit the patient to the vascular surgeon's care as soon as possible and in the best hemodynamic conditions. 2. The hospital stage when the therapeutic objectives are represented by: a) the treatment of hypovolemia; b) the curing of acute renal failure (bicarbonates 2 mmol.kg-1, hypertonic mannitol 1 g.kg-1; c) fight against infection; d) Heparin: 1 to 2 mg.kg-1 (if there is no counterindication); e) hyperbaric oxygen treatment in some situations. Despite the progress of reanimation, the initially intended amputation is subject to discussion in the following circumstances: crushing which in fact accomplishes an amputation, prolonged and complete ischemia lasting more than 10 to 12 hours, severe I.V.D.C., associated serious lesions (cranial traumatism, pelvis crushing).
Département d'Anesthésie-Réanimation, C.H.U., Angers.
J C
JC
Granry
J F
JF
Houet
J P
JP
Jacob
A
A
Delhumeau
D000208:Acute Disease; D000768:Anesthesia, General; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011150:Popliteal Artery / Q000293:injuries* / Q000503:physiopathology; D012151:Resuscitation
Physiopathologie et traitement médical de l'occlusion traumatique aiguë de l'artère poplitée. Le point de vue de l'anesthésiste-réanimateur.