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Peripheral ischemia caused by paradoxical embolization: an underestimated problem?

Beate Hugl1, Peter Klein-Weigel, Lydia Posch

  • 1Department of Vascular Surgery, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria. beate.hugl@uibk.ac.at

The Mount Sinai Journal of Medicine, New York
|May 26, 2005
PubMed

Insights

Paradoxical embolization through a patent foramen ovale (PFO) is an underrecognized cause of acute limb ischemia. This study highlights 5 cases treated with catheter thrombectomy, suggesting PFO

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Neurology

Background:

  • A patent foramen ovale (PFO) is a common cardiac anomaly, often asymptomatic.
  • PFO is a known risk factor for cryptogenic stroke and transient ischemic attacks.
  • Paradoxical embolization via PFO is typically associated with cerebrovascular events, not peripheral ischemia.

Observation:

  • This single-center study observed 5 consecutive patients presenting with limb-threatening ischemia over one year.
  • These cases were attributed to paradoxical embolization originating from a PFO.
  • The incidence represented 10% of all embolectomies performed at the center during the study period.

Findings:

  • All 5 patients with acute limb ischemia secondary to paradoxical embolization were successfully treated with catheter thrombectomy.
  • Long-term oral anticoagulation was initiated post-procedure for all patients.
  • The findings suggest a potentially higher prevalence of PFO-related peripheral emboli than previously recognized.

Implications:

  • The role of paradoxical embolization through PFO in acute limb ischemia may be significantly underestimated.
  • Increased clinical suspicion for PFO is warranted in patients presenting with peripheral embolic events, especially younger individuals.
  • This underscores the importance of considering PFO in the differential diagnosis of unexplained limb ischemia.

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