Differential management of acute peripheral arterial ischemia

Retrospective study of 140 consecutive cases of nontraumatic acute ischemia of the extremities of 48 hours or less duration emphasizes differences in diagnostic features, treatment, and results among 71 patients with arterial embolism (11% mortality rate) and 69 with acute atherosclerotic thrombosis (3% mortality rate). The following principles of management have evolved. (1) Although it is often difficult, differentiation between embolisms and acute thromboses is important. (2) Preoperative angiography is useful. (3) Immediate heparinization is indicated. However, it is not a suitable substitute for a necessary operation. (4) Long-term heparin therapy (instead of operation) does not produce better results for an embolism. However, it is useful for recent acute thrombosis with a viable limb. (5) Thrombectomy alone is not sufficient for acute atherosclerotic thrombosis. (6) Completion angiography is required. (7) Embolisms are more dangerous than acute thromboses, probably because of more serious accompanying cardiac lesions.