What are the causes of embolic lesions on the hands?

From the Guidelines

Embolic lesions on the hands are most commonly caused by septic thrombosis due to a peripheral arterial catheter, which can present with pseudoaneurysm or embolic lesions of the involved hand 1. The causes of embolic lesions on the hands can be varied, but they often indicate a serious underlying condition.

• Septic thrombosis is a serious complication of intravascular catheterization and may involve central veins or arteries after prolonged dwell times 1.
• Other potential causes of embolic lesions on the hands include infective endocarditis, atrial fibrillation, vasculitis, or cholesterol emboli syndrome.
• Initial management includes blood cultures, echocardiography, and appropriate antibiotic therapy if infection is suspected.
• For infective endocarditis, empiric antibiotics like vancomycin 15-20 mg/kg IV every 12 hours plus ceftriaxone 2g IV daily should be started immediately after blood cultures are drawn.
• Anticoagulation may be necessary for emboli related to atrial fibrillation, typically with direct oral anticoagulants like apixaban 5mg twice daily or warfarin with a target INR of 2-3.
• For vasculitis-related emboli, immunosuppressive therapy with corticosteroids and possibly cyclophosphamide or rituximab may be required.
• Cholesterol emboli syndrome often necessitates stopping anticoagulants and managing with statins and supportive care.
• A recent study published in 2023 found that septic thrombosis due to a peripheral arterial catheter can present with embolic lesions of the involved hand, highlighting the importance of prompt diagnosis and treatment 1.
• Another study published in 2015 found that infective endocarditis is a significant cause of embolic events, and that vegetation size and mobility are important predictors of embolic risk 1.
• The most recent and highest quality study, published in 2023, suggests that septic thrombosis due to a peripheral arterial catheter is a common cause of embolic lesions on the hands, and that prompt diagnosis and treatment are essential to prevent permanent damage to affected tissues 1.

From the Research

Causes of Embolic Lesions on the Hands

• Embolic lesions on the hands can be caused by various factors, including:
  • Traumatic vascular lesions 2
  • Peripheral hemangiomas 2
  • Neoplasms of an extremity 2
  • Infective endocarditis complicated by embolic events 3
  • Atherosclerotic lesions of the aortic arch 4
• Embolic events can also be a complication of medical procedures, such as:
  • Percutaneous transcatheter embolization 2
  • N-butyl cyanoacrylate embolotherapy 5
  • Carotid artery stenting (CAS) 6

Risk Factors and Predictors

• Certain factors can increase the risk of embolic lesions, including:
  • Presence of atherosclerotic plaques 3, 4
  • Mobile lesions in the aortic arch 4
  • High embolic potential, especially in young patients with no calcified plaques 4
• Predictors of embolic events may include:
  • Echocardiographic characteristics 3
  • Blood biomarkers, such as C-reactive protein and D-Dimer 3
  • Microbiological or clinical characteristics 3