From the Guidelines
A saddle embolus is a life-threatening condition that typically presents with sudden onset of bilateral lower-limb ischemia, occasionally associated with reversible paraplegia and a high mortality rate. The signs and symptoms of a saddle embolus can be remembered by the 5 "Ps": pain, paralysis, paresthesias, pulselessness, and pallor, with some clinicians also including a sixth "P" for polar, indicating a cold extremity 1.
Key Signs and Symptoms
- Sudden onset of bilateral lower-limb ischemia
- Reversible paraplegia
- High mortality rate
- Pain
- Paralysis
- Paresthesias
- Pulselessness
- Pallor
- Cold extremity (polar)
Clinical Presentation
The clinical diagnosis of arterial embolism, such as a saddle embolus, 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.
Importance of Prompt Treatment
Given the high mortality rate associated with a saddle embolus, prompt treatment with systemic anticoagulation is crucial to prevent further thrombus propagation and to improve outcomes. The location of the obstruction and the capacity of the collaterals to perfuse the ischemic territory also affect the severity of ischemia, highlighting the need for immediate medical attention 1.
From the Research
Signs and Symptoms of Saddle Embolus
The signs and symptoms of a saddle embolus can vary, but some common presentations include:
- Dyspnea (shortness of breath) 2, 3, 4, 5
- Pleuritic pain (chest pain that worsens with breathing) 2
- Syncope (fainting) 5
- Hypotension (low blood pressure) 4, 5
- Hypoxemia (low oxygen levels in the blood) 3
- Pulse attenuation of the radial artery and upper limb pain 3
- Right ventricular strain or dysfunction, which can be detected by echocardiography 6, 4
Clinical Presentation
Saddle pulmonary embolism can present asymptomatically, and some patients may not exhibit typical symptoms 2. The clinical presentation can also vary widely, and some patients may experience transient hypotension or persistent shock 4.
Risk Factors and Outcomes
The most common risk factors for saddle pulmonary embolism include obesity 5, recent surgery 4, and malignancy 4. The outcomes for patients with saddle pulmonary embolism can vary, but most patients respond to standard management with anticoagulation therapy 4, 5. However, some patients may require additional therapy, such as thrombolytic therapy or inferior vena cava filter placement 4, 5. The in-hospital mortality rate for saddle pulmonary embolism is relatively low, but some patients may die following hospitalization due to progressive malignancy or other causes 5.