What Is an Arterial Embolization?

Acute arterial embolism refers to the embolus from the heart, the proximal arterial wall, or other sources rushing into the arterial blood flow and embolizing the smaller diameter branch artery at the distal end, which in turn causes ischemic blood supply organs or limbs Necrosis. More common in the lower limbs, severe cases will eventually lead to amputation.

Basic Information

English name: acute arteria embolism
Visiting department: Vascular surgery
Common locations: Lower limb
Common causes: Atrial fibrillation is closely related to embolism. Shedding of thrombi in aneurysms or artificial blood vessels, atherosclerotic plaques, cholesterol emboli, etc. can cause

Common symptoms: Pain, numbness, dyskinesias; paleness, coldness; weakened or disappeared arterial pulse

Causes of Acute Arterial Embolism

The emboli that cause acute arterial embolism are divided according to source:

Cardiogenic emboli

About 90% of the emboli come from the heart. Atrial fibrillation is closely related to embolism. Most of the embolism caused by atrial fibrillation is from the left atrium wall thrombus.

2. Non-cardiogenic emboli

Vascular origin, such as shedding of thrombi in aneurysms or artificial blood vessels, atherosclerotic plaques, cholesterol emboli.

3. Source of unknown emboli.

Clinical manifestations of acute arterial embolism

The typical manifestations of acute arterial embolism include the "5P" sign, namely pain, numbness (parasthesia), dyskinesia (paralysis), pulselessness, and paler.

Pain

Most patients with acute arterial embolism complain of severe pain in the affected limb. The location of the pain mainly depends on the location of the embolism. Generally, the pain in the affected limb far from the level of acute arterial embolism is painful. With the formation and extension of secondary thrombosis, the pain plane can develop proximally.

2. Numbness and movement disorders

Because the nerve tissue is quite sensitive to ischemia, sensory and dyskinesia of the affected limb occurs early in the acute arterial embolism. It is manifested by the presence of a sock-shaped sensory loss zone in the distal end of the affected limb, a hyposensory zone in the proximal end, and a hypersensitivity zone in the proximal end. In addition, the affected limb has muscle weakness, paralysis, and different degrees of hand and foot drooping. When muscle necrosis eventually occurs and motor function is completely lost, it indicates that the affected limb is about to undergo irreversible changes.

3. Pale and cold

Violet plaques scattered between pale skin are visible. The limbs are severely ischemic, so the skin is cold, especially at the extremities. It should be pointed out that the plane of skin color and skin temperature change of the affected limb is usually one palm lower than the embolism site and two joint planes.

4. Arterial pulsation weakens or disappears

Embolism and arterial spasm, leading to a significant weakening or disappearance of arterial pulsation distal to the embolization plane.

Acute arterial embolization

Color Doppler ultrasound

Understand the embolization site and the patency of the downstream arteries.

2. Segmental manometry

Doppler pressure measurement was performed on the limb arteries to objectively understand the blood supply of the limbs.

3.CTA, MRA

Understand the embolization site, emboli morphology, whether the downstream distal artery is unobstructed and the collateral circulation.

4. Arteriography

The gold standard for diagnosis, but it is an invasive test. Generally not preferred.

Diagnosis of acute arterial embolism

Acute arterial embolism has significant symptoms and signs. Those with a history of atrial fibrillation, recent myocardial infarction, or the above-mentioned causes of sudden onset of "5P" signs and assisted examination of CTA manifestations make it easier to make a clinical diagnosis.

Differential diagnosis of acute arterial embolism

Acute arterial thrombosis

Often occurs on the basis of arteriosclerotic occlusion. It has a similar "5P" sign as acute arterial embolism, but due to chronic ischemia with collateral circulation establishment, the necrosis rate of the affected limb is low. The history of this disease has chronic ischemic manifestations of arteriosclerotic occlusion, such as intermittent claudication, resting pain and so on.

Aortic dissection

It can also cause acute lower limb ischemia, but it is often accompanied by chest pain or back pain, and has a history of hypertension or Marfan syndrome.

3. Femoral bruising

Symptoms and signs such as severe pain, chills, paleness, and weakening and disappearance of arterial pulsations in the distal limbs similar to acute arterial embolism may occur when acute deep venous thrombosis of the lower limbs is accompanied by compression of the arteries or arterial spasms. Improved after 12-24 hours. The disease also has signs of swelling of the affected limb, which is lacking in acute arterial embolism, and superficial varicose veins.

4. Arterial spasm

Due to surgical stimulation and trauma, vasodilator drugs are effective.

5. Other

Diseases to be identified include iliac artery compression syndrome, extra-arterial pressure lesions, and limb arterial trauma.

Acute arterial embolization

Non-surgical treatment

It is mainly suitable for early patients with mild limb dysfunction and incomplete embolization, or as an adjuvant treatment for surgery.

Since secondary thrombosis can occur on the basis of acute arterial embolism, anticoagulant therapy such as heparin and warfarin can be used to prevent thrombosis from aggravating the disease. Antiplatelet therapy inhibits platelet adhesion, aggregation, and release responses. Remove vasospasm treatment and actively deal with primary diseases such as atrial fibrillation and myocardial infarction. Treatment of muscular and renal metabolic syndrome, hyperkalemia, acidosis, myoglobinuria, oliguria, and anuria must be treated in time, otherwise irreversible renal function damage will occur.

2. Surgical treatment

It is the main method to treat acute arterial embolism. Limb ischemic and necrotic time is generally 4 to 8 hours, so the earlier the operation time, the better. Otherwise, the rate of amputation increases with prolonged arterial embolization.

(1) Surgical thrombectomy is an important method for treating arterial embolism of lower extremities. Embolization should be performed within 6 hours, usually no more than 12 hours. Should be preferred.

(2) Thrombolytic therapy At present, interventional inferior arterial catheter thrombolysis is the main method of thrombolytic therapy. Within 14 days of embolization, catheter thrombolysis is effective. Compared with surgical treatment, the advantages are that it can dissolve the small arterial thrombus, gradually open the collaterals, reduce ischemia-reperfusion injury, and minimize trauma.