Arterial Embolism

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Patient Advice

Definition

Arterial Embolism occurs when a blood clot or other embolus obstructs blood flow in an artery, leading to acute ischaemia in the affected tissues or organs.

Aetiology

Common causes of arterial embolism include:

  • Cardiac Emboli: Clots formed in the heart due to atrial fibrillation, valvular heart disease, or left ventricular thrombus.
  • Atheroemboli: Cholesterol or plaque fragments dislodged from atherosclerotic vessels.
  • Embolisation from Aneurysms: Clots or debris arising from aneurysmal sacs.
  • Foreign Material: Emboli due to catheterisation or other invasive procedures.

Pathophysiology

Arterial embolism leads to acute ischaemia through the following mechanisms:

  • Embolus Lodgement: The embolus obstructs an artery, blocking oxygen and nutrient supply to downstream tissues.
  • Ischaemia: Tissue hypoxia results in pain, dysfunction, and potential necrosis.
  • Inflammatory Response: Further exacerbates local tissue damage.

Risk Factors

Factors increasing the likelihood of arterial embolism include:

  • Atrial fibrillation or other arrhythmias.
  • Recent myocardial infarction.
  • Prosthetic heart valves.
  • Atherosclerosis or large artery plaque formation.
  • Endocarditis or other cardiac infections.
  • Hypercoagulable states (e.g., malignancy or inherited thrombophilias).

Signs and Symptoms

Symptoms of arterial embolism typically appear suddenly and include:

  • Pain: Severe and sudden in the affected limb or organ.
  • Pulselessness: Absence of pulses distal to the occlusion.
  • Pallor: Pale appearance of the affected limb.
  • Paresthesia: Tingling or numbness due to nerve ischaemia.
  • Paralysis: Muscle weakness or inability to move the affected limb.
  • Poikilothermia: Affected limb feels cold compared to the contralateral side.

Investigations

Key investigations and common positive findings include:

  • Clinical Assessment: A detailed physical exam to identify the "6 Ps" (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia).
  • Duplex Ultrasound: Non-invasive imaging showing absent blood flow in the affected artery.
  • CT Angiography: Identifies the location and extent of arterial occlusion.
  • Echocardiography: To detect cardiac sources of emboli, such as clots or valvular vegetations.
  • Blood Tests:
    • D-dimer: Elevated in thromboembolic conditions.
    • Coagulation Profile: To identify clotting abnormalities.

Management

1. Primary Care Management

  • Immediate Referral: Urgent referral to secondary care for further evaluation and treatment.
  • Oxygen Therapy: To optimise oxygenation if systemic hypoxia is suspected.
  • Pain Management: Use paracetamol or ibuprofen to relieve symptoms.

2. Secondary Care Management

  • Anticoagulation: Administer heparin to prevent further clot formation.
  • Thrombolysis: Infusion of clot-dissolving agents (e.g., alteplase) directly into the affected artery.
  • Embolectomy: Surgical removal of the embolus via a catheter. Performed by a vascular surgeon.
  • Bypass Surgery: Creating a graft to reroute blood flow around the blockage, if necessary.

3. Specialist Procedures

  • Endovascular Thrombectomy: Performed by interventional radiologists for precise removal of emboli.
  • Open Surgery: Reserved for extensive occlusions or failed endovascular treatments, performed by vascular surgeons.

Patient Advice

Key advice includes:

  • Take anticoagulants or other prescribed medications as directed.
  • Maintain an active lifestyle and avoid prolonged immobility to prevent further events.
  • Seek immediate medical attention for symptoms such as sudden limb pain or coldness.
  • Adhere to follow-up appointments to monitor vascular health and adjust treatment as necessary.
 
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