Arterial Occlusion

Basics

Description

Immediate and severe compromise of the blood supply to a limb, threatening its viability, secondary to the sudden blockage of a peripheral artery
  • Arterial embolization:
    • Thrombus or plaque
    • Originates from the heart (atrial fibrillation) aneurysms, atherosclerotic lesions or previous graft/stent sites
    • Emboli typically lodge where there is an acute narrowing of the artery or branch site
    • 75% of emboli involve an axial limb vasculature:
      • Femoral 28%
      • Arm 20%
      • Aortoiliac 18%
      • Popliteal 17%
      • Visceral and other 9%
  • Thrombosis
  • Arterial dissection
  • Trauma:
    • Crush injuries
    • Compression
    • Arterial contusion and thrombosis
    • Arterial transection
  • Limb ischemia >6 hr usually results in functional impairment or limb loss:
    • If acute on chronic, collateral circulation may preserve tissue beyond 6 hr
    • Distal blood flow is entirely dependent on collateral circulation
  • Thrombus extends proximally and distally as time goes on due to low flow

Etiology

  • Embolus:
    • Atrial fibrillation
    • Myocardial infarction
    • Valvular disease
    • Endocarditis
    • Atrial myxoma
    • Aneurysm
    • Atherosclerotic plaques
    • Paradoxical embolus (venous thromboembolism entering arterial system through communication i.e., PFO)
  • Thrombosis:
    • Vascular grafts
    • Atherosclerosis
    • Thrombosis of an aneurysm
    • Entrapment syndrome
    • Hypercoagulable disorders
    • Low flow state
    • Heparin-induced thrombosis
  • Arterial dissection
  • Arterial injury:
    • Intimal flap
    • Dissection
    • Pseudoaneurysms
    • Iatrogenic:
      • Catheterization
      • Arteriography
      • Balloon angioplasty
      • Complication of arterial puncture
    • Penetrating trauma:
      • Gunshot, stab wounds, shotgun, shrapnel
      • IV drug use
    • Blunt trauma
      • Joint displacement
      • Fracture
      • Compartment syndrome

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