Acute Arterial Occlusion

Wikis > Peripheral Vascular Disease > Acute Arterial Occlusion

Acute Arterial Occlusion/Acute Ischaemia/Arterial Embolism

Acute ischaemia due to arterial emboli from elsewhere in body interrupting blood flow in artery

85% from heart (most commonly from atrial fibrillation; previously rheumatic heart disease was most common. Most common source outside heart is an ulcerating atheromatous plaque – tend to lodge at areas of arterial branching or tapering  affects viability of distal tissues. Can also be due to trauma or acute thrombosis (usually at point of narrowing in atherosclerotic vessel).

Irreversible damages occur 4- 6 hours after onset of ischaemia.

Risk Factors:
Myocardial infarction; mitral valve stenosis; atrial fibrillation

Clinical Features:
Six ‘P’s’ – Pain; Pallor; Paraesthesia; Paralysis; Pulseless; Polar or Poikilothermy (coldness)
Usually sudden onset of pain, weakness and absent pulse distal to obstruction  progress to paraesthesia. ‘Dead’ feeling. Extremity is pale and cool – foot appears ‘waxy’. Veins fail to fill. Pulse proximal to obstruction may be exaggerated. Often do not have signs of chronic arterial insufficiency.
If have extensive collateral circulation  may not have much pain.

Management:
Usually have poor general health  contributes to high mortality
IV heparin.
Surgical thromboectomy

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