Arterial embolism
Encyclopedia
Arterial embolism is a sudden interruption of blood flow to an organ or body part due to an embolus
adhering to the wall of an artery
and blocks the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmonary embolism
is classified as arterial embolism as well, in the sense that the clot follows the pulmonary artery
carrying deoxygenated blood away from the heart. However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins. Arterial embolism is the major cause of infarction
(which may also be caused by e.g. arterial compression, rupture or pathological vasoconstriction
).
Later symptoms are closely related to infarction
of the affected tissue. This may cause permanently decreased organ function.
For example, symptoms of myocardial infarction
mainly include chest pain
, dyspnea
, diaphoresis
(an excessive form of sweating
), weakness, light-headedness, nausea
, vomiting
, and palpitation
s.
Symptoms of limb infarction
include coldness, decreased or no pulse beyond the site of blockage, pain, muscle spasm, numbness and tingling, pallor
and muscle weakness
, possibly to the grade of paralysis
in the affected limb.
and mitral stenosis
), injury or damage to an artery wall, and hypercoagulability (such as increased platelet count). Mitral stenosis
poses a high risk for embolization especially for those traveling to the brain and cause stroke
. Endocarditis
increases the risk for thromboembolism, by a mixture of the factors above.
Atherosclerosis
in the aorta and other large blood vessels is a common risk factor, both for thromboembolism and cholesterol embolism
. The legs and feet are major impact sites for these types. Thus, risk factors for atherosclerosis are risk factors for arterial embolisation as well:
Other important risk factors for arterial embolism include:
A septal defect of the heart makes it possible for paradoxical embolization, which happens 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 cause arterial embolisation.
, possibly resulting in infarction
with tissue death (necrosis
). Individuals with arterial thrombosis or embolism often develop collateral circulation
to compensate for the loss of arterial flow. However, it takes time for sufficient collateral circulation to develop, making affected areas more vulnerable for sudden occlusion by embolisation than for e.g. gradual occlusion as in atherosclerosis
.
In contrast, amniotic fluid embolism
almost exclusively affects the venous side.
in the arm or leg.
Tests to determine any underlying cause for thrombosis or embolism and to confirm presence of the obstruction may include:
, which is a major risk factor of arterial embolism, can be performed e.g. by dieting
, physical exercise
and smoking cessation
.
In case of high risk for developing thromboembolism, antithrombotic medication such as warfarin
or coumadin
may be taken prophylactically. Antiplatelet drugs may also be needed.
Medications include:
Appropriate drug treatments successfully produces thrombolysis and removal of the clot in 50% to 80% of all cases.
Antithrombotic agents may be administered directly onto the clot in the vessel using a flexible catheter (intra-arterial thrombolysis). Intra-arterial thrombolysis reduces thromboembolic occlusion by 95% in 50% of cases, and restores adequate blood flow in 50% to 80% of cases.
Surgical procedures include:
If extensive necrosis and gangrene has set in an arm or leg, the limb may have to be amputated. Limb amputation is in itself usually remarkably well-tolerated, but is associated with a substantial mortality (~50%), primarily because of the severity of the diseases in patients where it is indicated.
Without treatment, it has a 25% to 30% mortality rate
. The affected area can be permanently damaged, and up to approximately 25% of cases require amputation of an affected extremity.
Arterial emboli may recur even after successful treatment.
, approximately 550,000 people die each year from heart-related arterial embolism and thrombosis. Approximately 250,000 of these individuals are female, and approximately 100,000 of all these deaths are considered premature, that is, prior to the age of average life expectancy.
Embolus
An embolus is any detached, itinerant intravascular mass carried by circulation, which is capable of clogging arterial capillary beds at a site distant from its point of origin.By contrast there are non-traveling blockages that develop locally from vascular trauma or...
adhering to the wall of an artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
and blocks the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
is classified as arterial embolism as well, in the sense that the clot follows the pulmonary artery
Pulmonary artery
The pulmonary arteries carry deoxygenated blood from the heart to the lungs. They are the only arteries that carry deoxygenated blood....
carrying deoxygenated blood away from the heart. However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins. Arterial embolism is the major cause of infarction
Infarction
In medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
(which may also be caused by e.g. arterial compression, rupture or pathological vasoconstriction
Vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in...
).
Signs and symptoms
Symptoms may begin quickly or slowly depending on the size of the embolus and how much it blocks the blood flow. Symptoms of embolisation in an organ vary with the organ involved but commonly include:- Pain in the involved body part
- Temporarily decreased organ function
Later symptoms are closely related to infarction
Infarction
In medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
of the affected tissue. This may cause permanently decreased organ function.
For example, symptoms of myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
mainly include chest pain
Chest pain
Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...
, dyspnea
Dyspnea
Dyspnea , shortness of breath , or air hunger, is the subjective symptom of breathlessness.It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations...
, diaphoresis
Diaphoresis
Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
(an excessive form of sweating
Sweating
Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...
), weakness, light-headedness, nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, and palpitation
Palpitation
A palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself...
s.
Symptoms of limb infarction
Limb infarction
A limb infarction is an area of tissue death of an arm or leg. It may cause skeletal muscle infarction, avascular necrosis of bones, or necrosis of a part of or an entire limb.-Affected tissues:...
include coldness, decreased or no pulse beyond the site of blockage, pain, muscle spasm, numbness and tingling, pallor
Pallor
Pallor is a reduced amount of oxyhaemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, stimulant use, lack of exposure to sunlight, anaemia or genetics....
and muscle weakness
Muscle weakness
Muscle weakness or myasthenia is a lack of muscle strength. The causes are many and can be divided into conditions that have true or perceived muscle weakness...
, possibly to the grade of paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
in the affected limb.
Commonly occluded sites
Arterial emboli often occur in the legs and feet. Some may occur in the brain, causing a stroke, or in the heart, causing a heart attack. Less common sites include the kidneys, intestines, and eyes.Risk factors
Risk factors for thromboembolism, the major cause of arterial embolism, include disturbed blood flow (such as in atrial fibrillationAtrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
and mitral stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
), injury or damage to an artery wall, and hypercoagulability (such as increased platelet count). Mitral stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
poses a high risk for embolization especially for those traveling to the brain and cause stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
. Endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
increases the risk for thromboembolism, by a mixture of the factors above.
Atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
in the aorta and other large blood vessels is a common risk factor, both for thromboembolism and cholesterol embolism
Cholesterol embolism
Cholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels along with the bloodsteam to other places in the body, where it obstructs blood vessels...
. The legs and feet are major impact sites for these types. Thus, risk factors for atherosclerosis are risk factors for arterial embolisation as well:
- advanced age
- cigarette smoking
- hypertensionHypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
(high blood pressure) - obesityObesityObesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
- hyperlipidemiaHyperlipidemiaHyperlipidemia, hyperlipoproteinemia, or hyperlipidaemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood...
, e.g. hypercholesterolemiaHypercholesterolemiaHypercholesterolemia is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be caused by many diseases, notably cardiovascular disease...
, hypertriglyceridemiaHypertriglyceridemiaIn medicine, hypertriglyceridemia denotes high blood levels of triglycerides, the most abundant fatty molecule in most organisms. It has been associated with atherosclerosis, even in the absence of hypercholesterolemia . It can also lead to pancreatitis in excessive concentrations In medicine,...
, elevated lipoprotein (a) or apolipoprotein BApolipoprotein BApolipoprotein B is the primary apolipoprotein of low-density lipoproteins , which is responsible for carrying cholesterol to tissues. While it is unclear exactly what functional role APOB plays in LDL, it is the primary apolipoprotein component and is absolutely required for its formation...
, or decreased levels of HDL cholesterol) - diabetes mellitusDiabetes mellitusDiabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
- Sedentary lifestyleSedentary lifestyleSedentary lifestyle is a medical term used to denote a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a couch potato. It is commonly found in both the developed and developing world...
- stress
Other important risk factors for arterial embolism include:
- recent surgery (both for thromboembolism and air embolism)
- previous stroke or cardiovascular disease
- a history of long-term intravenous therapy (for air embolismAir embolismAn air embolism, or more generally gas embolism, is a pathological condition caused by gas bubbles in a vascular system. The most common context is a human body, in which case it refers to gas bubbles in the bloodstream...
) - Bone fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
(for fat embolismFat embolismA fat embolism is a type of embolism that is often caused by physical trauma such as fracture of long bones, soft tissue trauma and burns.-Presentation:...
)
A septal defect of the heart makes it possible for paradoxical embolization, which happens 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 cause arterial embolisation.
Pathophysiology
An arterial embolism is caused by one or more emboli getting stuck in an artery and blocking blood flow, causing ischemiaIschemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
, possibly resulting in infarction
Infarction
In medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
with tissue death (necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
). Individuals with arterial thrombosis or embolism often develop collateral circulation
Collateral circulation
Collateral circulation is when an area of tissue or an organ has a number of different pathways for blood to reach it. This is often as a result of anastamoses - branches formed between adjacent blood vessels....
to compensate for the loss of arterial flow. However, it takes time for sufficient collateral circulation to develop, making affected areas more vulnerable for sudden occlusion by embolisation than for e.g. gradual occlusion as in atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
.
Materials
Arterial embolisms can be consist of various materials, including:- Thromboembolism – embolism of thrombus or blood clot.
- Cholesterol embolismCholesterol embolismCholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels along with the bloodsteam to other places in the body, where it obstructs blood vessels...
- embolism of cholesterol, often from atherosclerotic plaque inside a vessel. - Fat embolismFat embolismA fat embolism is a type of embolism that is often caused by physical trauma such as fracture of long bones, soft tissue trauma and burns.-Presentation:...
– embolism of bone fracture or fat droplets. - Air embolismAir embolismAn air embolism, or more generally gas embolism, is a pathological condition caused by gas bubbles in a vascular system. The most common context is a human body, in which case it refers to gas bubbles in the bloodstream...
(also known as a gas embolism) – embolism of air bubbles. - Septic embolismSeptic embolismA septic embolism is a type of embolism that is infected with bacteria, resulting in the formation of pus. These may become dangerous if dislodged from their original location. Like other emboli, a septic embolism may be fatal....
– embolism of pus-containing bacteria. - Cancer embolism
In contrast, amniotic fluid embolism
Amniotic fluid embolism
Amniotic fluid embolism is a rare and incompletely understood obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic reaction. This reaction then results in cardiorespiratory ...
almost exclusively affects the venous side.
Diagnosis
In addition to evaluating the symptoms above, the health care provider may find decreased or no blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
in the arm or leg.
Tests to determine any underlying cause for thrombosis or embolism and to confirm presence of the obstruction may include:
- Doppler ultrasound, especially duplex ultrasonography. It may also involve transcranial dopplerTranscranial dopplerTranscranial Doppler is a test that measures the velocity of blood flow through the brain's blood vessels. Used to help in the diagnosis of emboli, stenosis, vasospasm from a subarachnoid hemorrhage , and other problems, this relatively quick and inexpensive test is growing in popularity in the...
exam of arteries to the brain - EchocardiographyEchocardiographyAn echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart . Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart...
, sometimes involving more specialized techniques such as Transesophageal echocardiography (TEE) or myocardial contrast echocardiography (MCE) to diagnose myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die... - Arteriography of the affected extremity or organ Digital subtraction angiographyDigital subtraction angiographyDigital subtraction angiography is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a 'pre-contrast image' or the mask from later images, once...
is useful in individuals where administration of radiopaque contrast material must be kept to a minimum. - Magnetic resonance imagingMagnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) - Blood testBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s for measuring elevated enzymes in the blood, including cardiac-specific troponin TTroponin TTroponin T is a part of the troponin complex. It binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex.The tissue specific subtypes are:* Slow skeletal troponin T1, TNNT1 * Cardiac troponin T2, TNNT2...
and/or troponin ITroponin ITroponin I is a part of the troponin complex. It binds to actin in thin myofilaments to hold the actin-tropomyosin complex in place. Because of it myosin cannot bind actin in relaxed muscle...
, myoglobins, and creatine kinaseCreatine kinaseCreatine kinase , also known as creatine phosphokinase or phospho-creatine kinase , is an enzyme expressed by various tissues and cell types. CK catalyses the conversion of creatine and consumes adenosine triphosphate to create phosphocreatine and adenosine diphosphate...
isoenzymes. These indicate embolisation to the heart that has caused myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
. Myoglobins and creatine kinase are also elevated in the blood in embolisation in other locations. - Blood cultures may be done to identify the organism responsible for any causative infection
- Electrocardiography (ECG) for detecting myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
- AngioscopyAngioscopyAngioscopy is a medical technique for visualizing the interior of blood vessels. In this technique, a flexible fiberoptic catheter inserted directly into an artery. It can be helpful in diagnosing e.g. arterial embolism....
using a flexible fiberoptic catheter inserted directly into an artery.
Prevention
Prevention of atherosclerosisAtherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
, which is a major risk factor of arterial embolism, can be performed e.g. by dieting
Dieting
Dieting is the practice of eating food in a regulated fashion to achieve or maintain a controlled weight. In most cases dieting is used in combination with physical exercise to lose weight in those who are overweight or obese. Some athletes, however, follow a diet to gain weight...
, physical exercise
Physical exercise
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...
and smoking cessation
Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
.
In case of high risk for developing thromboembolism, antithrombotic medication such as warfarin
Warfarin
Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
or coumadin
Coumadin
*For the rodenticide class of anticoagulant poisons sometimes loosely referred to as coumadins or coumarins, see 4-hydroxycoumarins.*For the pharmaceutical with the trade name Coumadin, see warfarin....
may be taken prophylactically. Antiplatelet drugs may also be needed.
Treatment
Treatment is aimed at controlling symptoms and improving the interrupted blood flow to the affected area of the body.Medications include:
- AntithromboticAntithromboticA antithrombotic is a drug which reduces thrombus formation.Different antithrombotics affect different processes:* Antiplatelet drugs limit the migration or aggregation of platelets.* Anticoagulants limit the ability of the blood to clot....
medication. These are commonly given because thromboembolism is the major cause of arterial embolism. Examples are:- AnticoagulantAnticoagulantAn anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
s (such as warfarinWarfarinWarfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
or heparinHeparinHeparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
) and antiplatelet medication (such as aspirinAspirinAspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
, ticlopidineTiclopidineTiclopidine is an antiplatelet drug in the thienopyridine family. Like clopidogrel, it is an adenosine diphosphate receptor inhibitor. It is used in patients in whom aspirin is not tolerated, or in whom dual antiplatelet therapy is desirable...
, and clopidogrelClopidogrelClopidogrel is an oral, thienopyridine class antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix. The drug works by irreversibly...
) can prevent new clots from forming - Thrombolytics (such as streptokinaseStreptokinaseStreptokinase , a protein secreted by several species of streptococci can bind and activate human plasminogen. SK is used as an effective and inexpensive thrombolysis medication in some cases of myocardial infarction and pulmonary embolism...
) can dissolve clots
- Anticoagulant
- Painkillers given intravenously
- Vasodilators to relax and dilate blood vessels.
Appropriate drug treatments successfully produces thrombolysis and removal of the clot in 50% to 80% of all cases.
Antithrombotic agents may be administered directly onto the clot in the vessel using a flexible catheter (intra-arterial thrombolysis). Intra-arterial thrombolysis reduces thromboembolic occlusion by 95% in 50% of cases, and restores adequate blood flow in 50% to 80% of cases.
Surgical procedures include:
- Arterial bypassCoronary artery bypass surgeryCoronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
surgery to create another source of blood supply - EmbolectomyEmbolectomyEmbolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi , and is then referred to as thrombectomy. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to...
, to remove the embolus, with various techniques available:- Thromboaspiration
- AngioplastyAngioplastyAngioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
with balloon catheterBalloon catheterA balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body...
ization with or without implanting a stentStentIn the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
Balloon catheterization or open embolectomy surgery reduces mortality by nearly 50% and the need for limb amputation by approximately 35%. - Embolectomy by open surgery on the artery
If extensive necrosis and gangrene has set in an arm or leg, the limb may have to be amputated. Limb amputation is in itself usually remarkably well-tolerated, but is associated with a substantial mortality (~50%), primarily because of the severity of the diseases in patients where it is indicated.
Prognosis
How well a patient does depends on the location of the clot and to what extent the clot has blocked blood flow. Arterial embolism can be serious if not treated promptly.Without treatment, it has a 25% to 30% mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
. The affected area can be permanently damaged, and up to approximately 25% of cases require amputation of an affected extremity.
Arterial emboli may recur even after successful treatment.
Complications
Possible complications of arterial embolism depend on the site of the obstruction:- In the heart it can cause myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
- In the brain, it can cause a transient ischemic attackTransient ischemic attackA transient ischemic attack is a transient episode of neurologic dysfunction caused by ischemia – either focal brain, spinal cord or retinal – without acute infarction...
(TIA), and, in prolonged blood obstruction, strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
. - Blockage of arteries that supply arms or legs may result in necrosis and gangreneGangreneGangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
- Temporary or permanent decrease or loss of other organ functions
- In septic embolismSeptic embolismA septic embolism is a type of embolism that is infected with bacteria, resulting in the formation of pus. These may become dangerous if dislodged from their original location. Like other emboli, a septic embolism may be fatal....
, there can be infection of the affected tissue or even septic shock,
Epidemiology
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, approximately 550,000 people die each year from heart-related arterial embolism and thrombosis. Approximately 250,000 of these individuals are female, and approximately 100,000 of all these deaths are considered premature, that is, prior to the age of average life expectancy.