The management of atheromatous emboli to the lower extremities

Atheromatous emboli to the small vessels of the feet usually cause painful, cyanotic areas on the distal portions of the extremity. Complete resolution of the symptoms is the rule, and recurrent episodes are common. Atheromatous emboli to the major vessels of the leg often cannot be distinguished from emboli originating from other sources, unless characteristic gross or microscopic features are present in the embolous material. If the embolus contains atheromatous debris or if the origin is uncertain, aortic arteriograms are indicated to determine if an ulcerated lesion may have been the source. Apparently, two mechanisms of embolization exist; they are fragmentation with distal embolization of atheromatous material and embolization of plateletfibrin thrombus material from ulcerated plaques. Endarterectomy of the involved segment of aorta has been uniformly successful in preventing recurrent episodes of embolization.