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Lower-extremity arterial emboli from ulcerating atherosclerotic plaques
JAMA
|February 23, 1979
Summary
Atherosclerotic plaques in the legs can cause emboli, leading to limb ischemia or livedo reticularis. Surgical intervention is preferred over anticoagulation for recurrent emboli from these sources.
Area of Science:
- Vascular Surgery
- Cardiology
- Dermatology
Background:
- Lower-extremity emboli can arise from atherosclerotic plaques.
- Ulcerated plaques present distinct clinical challenges.
- Distinguishing plaque emboli from cardiac emboli is crucial for treatment.
Purpose of the Study:
- To describe the clinical presentations of lower-extremity emboli originating from atherosclerotic plaques.
- To evaluate diagnostic methods and treatment efficacy for these emboli.
Main Methods:
- Retrospective review of ten cases with lower-extremity emboli.
- Analysis of clinical presentations, diagnostic imaging (biplanar aortography), and treatment outcomes.
- Comparison of emboli from cholesterol debris versus mural thrombi.
Main Results:
- Two presentations observed: widespread cholesterol emboli (digital ischemia, livedo reticularis) and larger thrombi mimicking cardiac emboli.
- Biplanar aortography proved essential for diagnosis.
- Anticoagulation failed to prevent recurrent embolization.
Conclusions:
- Lower-extremity emboli from ulcerated atherosclerotic plaques have distinct presentations.
- Surgical treatment (endarterectomy or graft replacement) is the preferred management.
- Lumbar sympathectomy can be beneficial for persistent cutaneous ischemia.