THROMBOEMBOLISM (Greek thiom-bos a piece, a clot + embole an insert, invasion) — the acute obstruction of blood vessels the blood clots which got to the circulating blood leading to the termination of blood supply on these vessels of the corresponding fabrics and bodies. T. makes nearly 99% of all types of an embolism (see) and treats the terrible, demanding emergency treatment complications of the diseases which are followed by formation of intravascular endocardiac blood clots of a pla in connection with hypercoagulation of blood (with - m. Thrombosis), defeat of vascular walls, napr, at atherosclerosis (see), rheumatism (see), a vasculitis (see), or an endocardium (see the Endocarditis), delay of a blood-groove owing to heart failure (see), priarit-miya of heart (see) etc. The state, at Krom is noted the increased tendency to an intravascular thrombogenesis and repeated T., sometimes call a clotting disease.
First descriptions of T. belong to R. Virkhov who created the theory of a thrombogenesis (1846—1853), K. To Rokshpansky who described a hemorrhagic heart attack of lungs (1846), 10. To Kongeym who showed a possibility of so-called paradoxical T. (1872).
The most frequent source of T. the blood clots which are formed in veins of a big circle of blood circulation, hl are. obr. in system of the lower vena cava; arterial and cardiac blood clots happen sources of T. approximately in 10% of cases. The blood clot which came off the place of an attachment or its fragment is transferred usually in the direction of a natural blood flow to vessels, a gleam to-rykh less than the sizes of an embolus — so-called direct type T. An exception are (1885) retrograde T described by F. Rek-lingkhauzen., when blood clot at the expense of gravity moves ahead on the lower vena cava against a blood flow and obturirut veins of a liver or kidneys.
In the place of implementation of an embolus allocate T. a small circle of blood circulation (including T. right cardial cavities), T. arteries of a big circle of blood circulation and T. systems of a portal vein. Blood clots from venas cava and the right cardial cavities cannot get into arteries of a big circle of blood circulation since meet an obstacle in vessels of lungs where they create — the most frequent option T. — a thromboembolism of pulmonary arteries (see). However with defects in partitions of heart (most often an oval window in an interatrial partition) the so-called paradoxical thromboembolism, i.e. an embolism of arteries of a big circle of blood circulation by the blood clots which passed from his veins through the available defect is possible.
Morphologically paradoxical T. it is characterized by existence of multiple embolisms of arteries of a big circle of blood circulation in the absence of a source of T. in the left half of heart or in an aorta, existence of the shunt between venous and arterial systems and a vein thrombosis of a big circle of blood circulation. Sometimes during the opening the blood clot which was implemented into a nezarashchenny oval window (fig.) is found. Usually source of T. arteries of a big circle of blood circulation pristenochny blood clots of an aorta and its large branches, especially an aneurysm of these vessels (see Aneurism, the Aortic aneurysm), or pristenochny blood clots in the left cardial cavities are at a myocardial infarction
of Fig. Makropreparat of heart at a paradoxical thromboembolism (the left auricle and a ventricle are opened): 1 — tromboembol, getting into the left auricle through a nezarashchenny oval window; 2 — an oval window with the site of not fusion in zadnenizhny department.
(see), a ciliary arrhythmia (see), aneurism of heart (see), an endocarditis (see). In case of an infectious valve endocarditis emboluses can be the cause of metastatic focuses of an infectious inflammation in a zone T. (so-called septic emboluses). Also the thromboembolism of system of a portal vein the blood clots which are formed in the veins draining abdominal organs at an inflammation of the last quite often has septic character; development of pileflebitichesky abscesses of a liver, napr is as a result possible, at destructive appendicitis, etc. (see the Pylephlebitis).
Rykhlo the blood clot connected with the place of the attachment can come off and turn into an embolus at sudden increase in intra belly and intrathoracic pressure (in particular, at defecation, cough), at acceleration of a blood-groove in connection with an exercise stress, fever, during the change of position of a body; the separation of endocardiac blood clot is promoted by strengthening of cordial reductions, including during the change of a cordial rhythm and at recovery of a sinoatrial rate after atrial fibrillation (so-called normalizing T.).
Wedge, manifestations of T. are defined by its localization and depend on caliber and the total amount of the vessels which are switched off from blood circulation. Massive T. large vascular trunks, in particular pulmonary, or vessels of vitals can be the cause of fulminant death. From arterial T. the greatest a wedge, T matter. arteries of a brain with development of an ischemic stroke (see), T. splenic or renal arteries with a heart attack (see) appropriate authority and T. arteries of a mesentery (see) about a wedge, a picture of a belly toad or an acute abdomen (see). Acute impassability of the main arteries of extremities is shown by disappearance of pulse and decrease in temperature of skin distalny the site of occlusion, an acute pain and disturbances of skin sensitivity, the blanching which is replaced by cyanosis, hypostasis of ischemic fabrics with threat of emergence in the subsequent gangrenes of an extremity (see. Obliterating defeats of vessels of extremities). Quite seldom T meet. coronary arteries about a wedge, a picture of acute coronary insufficiency and a macrofocal myocardial infarction (see). Acute occlusion of the main trunk or branches of a hepatic artery with formation of a heart attack of a liver (see) and T are exclusively seldom observed. vessels of a spinal cord with development of paralyzes and disorders of sensitivity.
V. D. Topolyansky; P.F. Kaliteevsky