Acute arterial occlusions

ACUTE ARTERIAL OCCLUSIONS

The presence of acute arterial ischemia usually indicates the presence of an underlying pathology that has to be treated for complete recovery.

Etiology

Embolism

Cardioarterial

Cardio-arterial emboli arise from heart. They are seen in cases of

Atrial fibrillation

Myocardial infarction

Bacterial endocarditis

Mitral stenosis

Atrial myxoma

Aneurysms

Arterioarterial

Arterio-arterial emboli arise from an atherosclerotic plaque with thrombosis.

Trauma

Trauma can lead to intrinsic compression from spasm / contusion / laceration Or extrinsic compression with soft tissue swelling leading to acute compartmental syndrome

Acute thrombosis

Acute thrombosis can occur following

Disruption of a plaque

Shock leading to hypoperfusion

CCF

Aneurysmal sac

Catheterization - Catheterization may damage the endothelium and initiate thrombosis or may dislodge an already formed thrombus.

Neoplasia - Neoplasia may occlude artery suddenly following malignant embolization or due to sudden bleed.

Site of occlusion

70% extremities, 10% cerebral, 5% visceral arteries

Effect on organs

Site Brain (MCA) - Hemiplegia / transient ischemic attack

Retina (Regional artery) -Amaurosis fugax

Mesenteric artery -Gangrene of the loop

Splenic artery -Infarct and pain

Kidney -Infarct, pain, hematuria

Lungs - Fatal pulmonary embolism

Extremities -Peripheral limb ischemia