Atheromatous embolisation/Emboli of microcirculation
Small or micro emboli of arterioles and capillaries. Frequently overlooked as a diagnosis. Accounts for 2.5% of all vascular consultations in one series
May be spontaneous or precipitated by arteriography, surgery, or the use of anticoagulant or thrombolytic drugs. Aneurysms of popliteal artery are common source.
Clinical features:
Usually have history of atherosclerosis and symptoms associated with it.
Most are smokers.
Local signs and symptoms will depend on organ:
Kidney renal failure, hypertension
Cardiac myocardial infarction
Gastrointestinal abdominal pain, bleeding, ischaemic bowel
Neurological TIA, CVA
Systemic fever, weight loss, malaise
Foot:
Most common changes affect the skin on the lower abdomen, leg and foot livedo reticularis appearance (common and not affected by limb elevation or digital compression).
Ischaemic pain at tips of toes; may progress to ulceration and gangrene.
Often present with sudden appearance of painful, discoloured toe or small area of foot with palpable pulses.
Blue or purple cyanotic and painful toes are common. The discolouration may also affect the plantar surface of the foot – if pulses are palpable highly suggestive of diagnosis
Initial episode may only last as short as a few minutes – but usually a few days (depends on collateral circulation). Further episode are highly probable risk for tissue loss.
May have ‘restless legs’ type symptoms.
Management:
Analgesics for pain control. Topical vasodilators have been used (not much known on efficacy)
Avoidance of anticoagulants (or use with extreme care)
Surgical removal of source of emboli
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