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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