Post-ischemia syndrome
| Classification according to ICD-10 | |
|---|---|
| I74 | Arterial embolism and thrombosis |
| N47 | Foreskin hypertrophy, phimosis and paraphimosis |
| T92.9 | Consequences of an unspecified upper extremity injury |
| T93.9 | Consequences of an unspecified lower extremity injury |
| T74.9 | Abuse of persons, unspecified |
| T75.8 | Other specified damage from external causes |
| ICD-10 online (WHO version 2019) | |
The term post-ischemia syndrome describes the symptoms that occur as a result of long-term circulatory disorders in different parts of the body ( reperfusion damage - acute after reopening of occluded blood vessels). Depending on the size of the affected area, it can be life-threatening. Typical causes are arterial vascular occlusion (e.g. embolism or Leriche syndrome ), paraphimosis , compartment syndrome and strangulation of extremities due to foreign materials ( tourniquet syndrome ).
In the literature, the term is sometimes used synonymously with tourniquet syndrome , which describes the constriction of individual extremities by foreign material, especially in children.
Causes and consequences
A post-ischemia syndrome can occur after a closure time of the arterial blood flow of 5 hours. After the restoration of the blood flow, massive edema occurs in the affected area of the body, and on the other hand, toxic metabolic products that have entered the local bloodstream during the ischemia period, as well as potassium and myoglobin (from damaged muscle cells) are distributed throughout the body. Depending on the size of the body portion concerned edema may be sufficient, a relevant dehydration (in the sense of hypovolemic Schockes) trigger, which is flooded potassium can lead to relevant hyperkalemia (disturbance of the heart activity) and is flooded myoglobin to kidney failure up to anuria ( crush Kidney ). In the long term, in addition to acute, potentially life-threatening symptoms, changes in the hands ( Dupuytren's disease ) and feet ( hammer toe ) can develop.
therapy
The main focus of the treatment is the restoration of blood circulation (causal therapy). Depending on the cause, it is sufficient to remove strangulations caused by foreign material (tourniquet syndrome). In the case of paraphimosis, the prepuce must be reduced or, if necessary, incised. In the case of the compartment syndrome, the splitting of the muscle boxes is essential and, if the cause is embolic, appropriate interventions (e.g. embolectomy ) are indicated. If correspondingly large areas of the body are affected, so that the resulting edema formation leads to a relevant lack of fluid and / or the inundation of substances pathologically present in the ischemic area leads to organ disorders, symptomatic therapy (e.g. appropriate replacement of fluid and stimulation of diuresis ) and In principle, intensive monitoring is also necessary. Severe post-ischemia syndrome can be an indication for amputation.
Individual evidence
- ↑ lexikon.meyers.de: Tourniquet Syndrome (page no longer available)
- ↑ a b A. Klusmann, HG Lenard: Tourniquet syndrome - accident or abuse? In: Eur J Pediatr. Volume 163, No. 8, Aug 2004, pp. 495-498. PMID 15179509
- ↑ H. Kristen: For the treatment of tourniquet syndrome with Trasylol. In: Langenbeck's Archives of Surgery. Springer, 1969, ISSN 1435-2443 , (online at: springerlink.com )
- ↑ a b G. Heberer et al.: Vascular surgery. Springer, 2003, ISBN 3-540-40564-X , p. 385, (online at: books.google.de )
- ↑ P. Brenner et al.: Dupuytren's disease. Springer, 2002, ISBN 3-211-83596-2 , pp. 21-23, (online at: books.google.de )
- ↑ H. Zwipp: Surgery of the foot. Springer, 1994, ISBN 3-211-82411-1 , p. 218, (online at: books.google.de )
