From the Guidelines
The most common cause of acute arterial occlusion is embolism, particularly from cardiac sources, such as atrial fibrillation, which accounts for approximately 80-90% of cases. This occurs when a blood clot forms in one location, breaks loose, and travels through the bloodstream until it lodges in a smaller artery, blocking blood flow 1. The clinical diagnosis of arterial embolism is suggested by the sudden onset or sudden worsening of symptoms, a known embolic source, the absence of antecedent claudication or other manifestations of obstructive arterial disease, or the presence of normal arterial pulses and Doppler systolic blood pressures in the contralateral limb 1.
Key Points to Consider
- Arterial emboli typically lodge at branch points in the arterial circulation where the caliber of the arterial lumen diminishes 1.
- Embolism to the aortoiliac bifurcation (“saddle embolus”) may produce bilateral lower-limb ischemia occasionally associated with reversible paraplegia and a high mortality rate 1.
- Acute limb ischemia may also occur as a result of acute arterial thrombosis superimposed on a stenotic atherosclerotic plaque, with a common site of thrombosis being the superficial femoral artery 1.
Important Considerations for Treatment
- Immediate recognition and treatment of acute arterial occlusion is essential to prevent tissue death 1.
- Interventions potentially include anticoagulation, thrombolysis, or surgical embolectomy depending on the location and severity of the occlusion 1.
- The hallmark clinical symptoms and physical examination signs of acute limb ischemia include the 5 “Ps” that suggest limb jeopardy: pain, paralysis, paresthesias, pulselessness, and pallor 1.
From the Research
Causes of Acute Arterial Occlusion
The most common causes of acute arterial occlusion can be identified through various studies, including:
- Embolism, which can originate from the heart, aorta, or other arteries 2, 3, 4
- Thrombosis, which can occur in patients with atherosclerosis, arterial trauma, or other conditions 2, 3
- Tumor embolism, which can cause acute arterial occlusion in patients with lung cancer or atrial myxoma 5
Risk Factors
Risk factors for acute arterial occlusion include:
- Aortic atherosclerosis
- Arterial trauma
- Recent myocardial infarction
- Atrial fibrillation 3
Sources of Embolism
The sources of embolism can vary, but common sources include: