Arterial embolism

Causes and Risks:
An embolism is a clot (or a piece of plaque that acts in the same manner as a clot) that travels from the site where it formed to another location in the body. The embolism can lodge in an artery at the new location and block the flow of blood in that location. The blockage deprives the tissues in that location of its normal blood flow and oxygen (ischemia). This can result in damage or destruction, even death of the tissues ( necrosis ), in that organ.

Arterial emboli may be caused by a single embolus or multiple emboli . Risks include atrial fibrillation , because the blood flow through the atria can be slow enough to trigger clots to form, which can then travel (embolize). Factors that indicate an increased tendency to form clots may also be associated with increased risk. These may include injury or damage to an artery wall, hematologic (blood component) conditions associated with increased clotting (such as increased platelet count ) and other disorders.

Arterial emboli may involve the extremities, especially the legs and feet. Some may involve the brain or heart, causing stroke or heart attack . Less common sites include the kidneys, gut (intestines), and other areas.

Prevention:
Prevention of arterial embolization begins with prevention of the source of the embolus . For example, blood thinners (such as Coumadin) may be used in certain situations to prevent formation of a blood clot that could be a source of the embolism . Measures to reduce atherosclerosis may reduce risk of an arterial embolus forming from a piece of atherosclerotic plaque. Such measures may include lifestyle and diet changes, medications, and similar measures.

Symptoms:
EMBOLIZATION IN AN EXTREMITY

Symptoms may begin abruptly or slowly depending on the size of the embolus and the extent to which it blocks the blood flow.

Later symptoms:

EMBOLI IN AN INTERNAL ORGAN (see complications)

  • symptoms of ischemia (lack of oxygen)
    • usually pain and/or temporary decreased function

  • symptoms of infarction (tissue death)
    • usually pain and/or loss of function of all or part of the organ



Signs and Tests:
There may be decreased or absent pulse , and/or decreased or absent blood pressure in the extremity. There may be signs of tissue necrosis or gangrene.

Tests that reveal arterial embolism may include:
arteriography/ angiography of the affected extremity or organ

This disease may also alter the results of the following tests:



Treatment:
Arterial embolism requires prompt treatment, usually with hospitalization.

Initial treatment:
The goals of treatment include improvement of blood flow to the affected area of the body and control of symptoms.

Medications may be helpful in improving blood flow and controlling symptoms. Thrombolytic medications (such as streptokinase) may be used to break up the clot . Anticoagulant medications (such as Coumadin or heparin) or antiplatelet medications such as aspirin may be used to prevent the development of new clots. Analgesics may be needed for pain control.

Surgery may be appropriate for some people. This may include open surgical removal of the clot (embolectomy) or balloon catheter clot removal (preferred, if feasible). Surgical replacement or bypass of the blood vessel is occasionally required.

The underlying cause of the emboli should be treated.

These additional measures may be used only if approved by the health care provider. They are aimed at protecting the affected part from further damage:

  • Keep an affected extremity warm but do not apply direct heat.
  • Keep an affected extremity at or below a horizontal position.
  • Protect an affected extremity from resting on hard surfaces, and do not allow pressure on the affected part.



Prognosis:
The outcome varies depending on the location of the embolism and the extent that the embolism affects blood supply to the area. Arterial embolism can be serious if not treated promptly. It may be life threatening, with 25 to 30% death rate. The affected area can be permanently damaged, with up to approximately 25% of cases requiring amputation of an affected extremity. Arterial emboli can recur even after successful treatment.

Complications:



Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate you may have an arterial embolism.