Acute Arterial Occlusion

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Radiology 6 Complications 7 Management 8 More General Terms 9 References

Introduction

• Sudden onset of severe limb ischemia.

Etiology

• thrombosis

• may form at site of stenosis in an atherosclerotic artery or bypass graft
• procoagulant disorders may cause thrombus formation in normal arteries

• heparin-induced thrombocytopenia
• antiphospholipid antibody syndrome
• hyperhomocysteinemia

• embolism

• most common cause
• 85% originate from cardiac thrombi
• systemic emboli from deep venous thrombosis ( DVT) that enters arterial circulation via a patent foramen ovale or an atrial septal defect ( ASD)
• emboli originating from aneurysms of the aorta or peripheral arteries

• dissection
• trauma

Pathology

• irreversible changes occur as early as 4-6h after acute arterial occlusion

Clinical-manifestations

• pulseless
• painful
• pallor
• paresthesia
• paralysis
• poikilothermy

Radiology

• arteriography

• identify the site & nature of acute arterial occlusion
• distinguish thrombosis in situ from arterial embolism

Complications

• 
  
• disease interaction(s) of peripheral vascular disease with overflow incontinence

Management

• severe claudication but no pain at rest

• anticoagulation with heparin &
• antiplatelet therapy

• revascularization in a threatened, but viable limb [1,2]

• angioplasty or embolectomy catheter
• intra-arterial thrombolytic therapy

• urokinase or tPA better than streptokinase
• 82% salvage rate at 1 year

• surgical reconstruction (bypass) when angioplasty/ embolectomy & thrombolysis are not feasible or ineffective
• amputation if limb not viable [1,2]

• anesthesia, paralysis, absent doppler, muscle rigor

More General Terms

• peripheral vascular disease
• ischemia

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15 American College of Physicians, Philadelphia 1998, 2006, 2009
2. BASIL Trial Participants> Bypass versus angioplasty in severe ischaemia of the leg (BASIL): Multicentre, randomised controlled trial. Lancet 2005; 366:1925 PMID: [1]
   - Goy JJ & Urban P Life and limb: Bypass versus angioplasty in the ischaemic limb. Lancet 2005; 366:1905 PMID: [2]
3. National Guideline Clearinghouse ACR Appropriateness Criteria for sudden onset of cold, painful leg ngc-guideline: [3]
   - Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [4]

acute arterial occlusion (severe limb ischemia)