Arterial Embolism

What is the definition of Arterial Embolism?

Arterial embolism is a sudden interruption of blood flow to an organ or body part due to a clot (embolus) that has come from another part of the body.

What are the causes for Arterial Embolism?

An "embolus" is a blood clot or a piece of plaque that acts like a clot. The word "emboli" means there is more than one clot or piece of plaque. When the clot travels from the site where it formed to another location in the body, it is called an embolism.

An arterial embolism may be caused by one or more clots. The clots can get stuck in an artery and block blood flow. The blockage starves tissues of blood and oxygen. This can result in damage or tissue death (necrosis).

Arterial emboli often occur in the legs and feet. Emboli that occur in the brain cause a stroke. Ones that occur in the heart cause a heart attack. Less common sites include the kidneys, intestines, and eyes.

Risk factors for arterial embolism include:

• A type of abnormal heart rhythm called atrial fibrillation
• Injury or damage to an artery wall
• Conditions that increase blood clotting (such as a very high platelet count)

Another condition that poses a high risk for embolization (especially to the brain) is mitral stenosis. Endocarditis (infection of the inside of the heart) can also cause arterial emboli.

A common source for an embolus is from areas of hardening (atherosclerosis) in the aorta and other large blood vessels. These clots can break loose and flow down to the legs and feet.

Paradoxical embolization can take place when a clot in a vein enters the right side of the heart and passes through a hole into the left side. The clot can then move to an artery and block blood flow to the brain (stroke) or other organs.

If a clot travels and lodges in the arteries supplying blood flow to the lungs, it is called a pulmonary embolus.

What are the symptoms for Arterial Embolism?

You may not have any symptoms.

Symptoms may begin quickly or slowly depending on the size of the embolus and how much it blocks the blood flow.

Symptoms of an arterial embolism in the arms or legs may include:

• Cold arm or leg
• Decreased or no pulse in an arm or leg
• Fingers or hands feel cool
• Lack of movement in the arm or leg
• Muscle pain in the affected area
• Muscle spasm in the affected area
• Numbness and tingling in the arm or leg
• Pale color of the arm or leg (pallor)
• Weakness of an arm or leg

Later symptoms:

• Blisters of the skin fed by the affected artery
• Shedding (sloughing) of skin
• Skin erosion (ulcer)
• Tissue death (necrosis; skin is dark and damaged)

Symptoms of a clot in an organ vary with the organ involved but may include:

• Pain in the part of the body that is involved
• Temporarily decreased organ function

What are the current treatments for Arterial Embolism?

Arterial embolism requires prompt treatment at a hospital. The goals of treatment are to control symptoms and to improve the interrupted blood flow to the affected area of the body. The cause of the clot, if found, should be treated to prevent further problems.

Medicines include:

• Anticoagulants (such as warfarin or heparin) can prevent new clots from forming
• Antiplatelet medicines (such as aspirin or clopidogrel) can prevent new clots from forming
• Painkillers given through a vein (by IV)
• Thrombolytics (such as streptokinase) can dissolve clots

Some people need surgery. Procedures include:

• Bypass of the artery (arterial bypass) to create a second source of blood supply
• Clot removal through a balloon catheter placed into the affected artery or through open surgery on the artery (embolectomy)
• Opening of the artery with a balloon catheter (angioplasty) with or without a stent

What is the outlook (prognosis) for Arterial Embolism?

How well a person does depends on the location of the clot and how much the clot has blocked blood flow and for how long the blockage has been present. Arterial embolism can be very serious if not treated promptly.

The affected area can be permanently damaged. Amputation is needed in up to 1 in 4 cases.

Arterial emboli can come back even after successful treatment.

What are the possible complications for Arterial Embolism?

Complications may include:

• Acute MI
• Infection in the affected tissue
• Septic shock
• Stroke (CVA)
• Temporary or permanent decrease or loss of other organ functions
• Temporary or permanent kidney failure
• Tissue death (necrosis) and gangrene
• Transient ischemic attack (TIA)

When should I contact a medical professional for Arterial Embolism?

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of arterial embolism.

How do I prevent Arterial Embolism?

Prevention begins with finding possible sources of a blood clot. Your provider may prescribe blood thinners (such as warfarin or heparin) to prevent clots from forming. Antiplatelet drugs may also be needed.

You have a higher risk atherosclerosis and clots if you:

• Smoke
• Do little exercise
• Have high blood pressure
• Have abnormal cholesterol levels
• Have diabetes
• Are overweight
• Are stressed

REFERENCES

Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;135(12):e686-e725. www.ncbi.nlm.nih.gov/pubmed/27851991.

Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 51.

Kline JA. Pulmonary embolism and deep vein thrombosis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 78.

Patel MS, Chaikof EL. Peripheral arterial embolism. In: Cameron P, Jelinek G, Kelly A-M, Brown A, Little M, eds. Textbook of Adult Emergency Medicine. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:1031-1036.