Acute peripheral arterial occlusion

Acute arterial occlusion resulting in limb ischemia may be caused by a diverse array of conditions but most often is the result of an arterial embolism or thrombosis of a previously diseased vessel. Differentiation of these two primary entities may be difficult, but a careful history, thorough physical examination, and liberal use of arteriography can usually separate them. Distinction is important because an embolus is almost always best treated by prompt operation, whereas management of acute arterial thrombosis is often improved when the limb is viable, and emergency operation can be deferred. The significant underlying cardiac problems responsible for an embolus continue to cause appreciable morbidity and mortality after arterial embolectomy despite simplification in the operative procedure itself and steady improvement in limb salvage. Although the risk of emergency surgical treatment of acute arterial thrombosis is usually less than that associated with embolectomy, results of salvage of the limb are often less satisfactory. Nonoperative management of acute ischemia by high-dose antiocoagulation alone or use of fibrinolytic drugs may also be useful in specific circumstances. Exact indications for the use and likely benefits of such nonoperative therapy remain unsettled.