Arterial embolization: problems of source, multiplicity, recurrence, and delayed treatment

The clinical course of 225 patients who had experienced 309 arterial embolic episodes was reviewed with special reference to the problems of the identification of the source of embolization, multiplicity of involvement, significance of recurrence, and the effects of some therapeutic means, including anticoagulation, on the early and late results. The most common source of embolization was cardiac (in 85% of the cases). Persistent search, at times by complex diagnostic methods, uncovered the origin in all but 11% of the cases. Within a range of 8 hours to 7 days the effect of delayed treatment had a linear relationship to the severity of ischemic changes and the deterioration of favorable results. Angiography was helpful and often essential in the diagnosis of visceral embolism and in differentiating local thrombosis from embolism in the periphery. Recurrent embolization was common (in 28% of the cases), was often multiple, and had a grave prognosis. Permanent anticoagulant therapy, preferably with but even without the removal of the source of embolization, reduced the rate of recurrence and, in general, reduced early and late morbidity and mortality rates.