Occlusive extracraneal vascularopathy, acute mesenteric and renal ischemia and their effects on driving

Occlusive extracraneal vascularopathy, acute mesenteric and renal ischemia and their effects on driving Occlusive extracraneal vascularopathy, acute mesenteric and renal ischemia and their effects on driving

Different types of occlusive diseases of the carotid, vertebral and subclavial arteries produce very different clinical manifestations.

Unilateral carotid occlusion

This can produce transitory ipsilateral blindness, contralateral hemiplegia and aphasia of variable duration

Advice

  • When the patient suffers a transitory ischemic episode, driving is not possible until a vascular study allows for correct diagnosis and appropriate treatment.
  • These patients must be warned of the possible risk of a further episode occurring, which will make them aware of the danger associated with driving.
  • The specialist will inform the patient at each check up of his clinical situation and his ability to drive will be assessed.
  • It is important to highlight that patients with partial occlusion of the carotid can suffer a complete occlusion when making certain movements of the neck or getting into positions that are frequently necessary when driving a vehicle.
  • It is therefore important that the driver’s seat is high up, comfortable, with a straight back and a good headrest.
  • Panoramic rear view mirrors, correctly adjusted, will mean the driver can avoid forcing his neck into these positions.
  • Drivers who voluntarily limit neck movement in order to avoid the complete occlusion of the carotid should be warned not to drive.
  • If, while driving, the patient notices he is having the least difficulty, he should park the vehicle somewhere with no risk of an accident and ask for help.

Oclusion of the vertebro-basilar system

These usually produce bilateral symptoms that affect both arms or legs, with vertigo, thumping in the areas, dizziness, diplopia and dysarthria.

Loss of consciousness with rapid recovery, leaving residual dizziness and moderate ataxia is possible.

Advice

  • These symptoms mean that the driver could completely lose control of the vehicle and must not drive.
  • Specific vascular episodes will confirm the diagnosis and the risks of suffering from further episodes of a similar nature. In these cases, driving must not be permitted.

Acute mesenteric ischemia

The sudden occlusion of the superior mesenteric artery (SMA) produces, in just a few hours, intestinal gangrene.

  • SMA embolism occurs in patients with a previous history of cardiopathy, such as auricular fibrillation, acute myocardial infarct, artificial valves or previous and associated embolisms.The clinical manifestations of this are acute periumbilical abdominal pain, often accompanied by vomiting and diarrhoea, which develops quickly, and in a matter of a few hours causes death.

    This is the most frequent cause, which can be corrected with surgery.

  • SMA thrombosis develops on a previous stenosis on the plaque of an atheroma.The clinical manifestations are more insidious and the pain is not consistent with the serious situation which is developing.

    In almost half of all cases there is a previous history of chronic mesenteric ischemia and in most cases the patient is suffering from other atherosclerosis.

In all cases, only revascularisation surgery can offer a cure by means of a simple embolectomy or derivation techniques.

Advice

  • All varieties of this are serious and driving should not be permitted.
  • If the patient overcomes an acute episode, he will not be able to drive until the cause of the SMA obstruction has been resolved and the patient is completely recovered, with a medical report authorising him to drive.
  • Open surgery requires appropriate post operative care if correct scarring is to take place, which includes not straining, over taxing the patient with strenuous movements, and avoiding knocking the area.
  • Therefore, during this period, driving is not advised until the patient has been given a clean bill of health after the surgery and is told by the surgeon in his recommendations that he may once again drive.
  • Driving is not recommended until the emboligenic focus has been brought under control.
  • An anticoagulated patient should be warned of the increased risk of suffering haemorrhages even in the case of a small collision, and should be told to drive with extreme caution.

Acute renal ischemia

Unilateral renal embolism is a frequent cause of acute renal ischemia, although in a third of cases, it can be bilateral.

The pain can be sudden onset and progressive in the renal cavity, is continuous and does not radiate out.

It is generally accompanied by fever, hypertension, nausea, vomiting and anuria in bilateral cases or when the patient only has one kidney.

The treatment is conservative with heparin therapy and fibrinolytics, according the indications of the case, interventional by performance of an embolectomy or derivation, according to whether the problem is of embolic or thrombotic origin.

Nephrotomy is reserved for cases of irreversible renal ischemia.

Advice

  • This serious clinical condition means it is impossible for the patient to drive until he is completely better and has been given permission to do so by a specialist physician.
  • When open surgery is performed, the surgical wound means that the patient is not fit to drive.
  • Therefore, during this period, driving is not advised until the patient has been given a clean bill of health after the surgery and is told by the surgeon in his recommendations and warnings that he may once again drive.
  • The patient will not be able to drive while there is still a risk of further embolism, or the emboligenic focus has not been completely controlled.
  • An anticoagulated patient should be warned of the increased risk of suffering haemorrhages even in the case of a small collision, and should be told to drive with extreme caution.