cardiovascular disorders
Acute Peripheral Arterial Occlusion
Introduction
Peripheral arteries may be acutely occluded by a thrombus, an embolus, aortic dissection, or acute compartment syndrome. Acute peripheral arterial occlusion may result from: Rupture and thrombosis of an atherosclerotic plaque Embolus from the heart or thoracic or abdominal aorta Aortic Dissection None Acute Compartment Syndrome None Symptoms and signs are sudden onset in an extremity of the 5 P’s: Pain (severe) Pallor Paresthesias (or anesthesia) Polar sensation (coldness) Pulselessness Outcomes are best with early diagnosis, but pain, generally the earliest symptom, is nonspecific. However, the pain of acute arterial occlusion can be out of proportion to physical findings. Thus, acute peripheral arterial occlusion should be considered in patients at risk (eg, with known or suspected peripheral arterial disease) who have limb pain disproportionate to physical findings, particularly if onset is sudden. The occlusion can be roughly localized to the arterial bifurcation just distal to the last palpable pulse (eg, at the common femoral bifurcation when the femoral pulse is palpable; at the popliteal bifurcation when the popliteal pulse is palpable). Severe cases may cause loss of motor function. After 6 to 8 hours, muscles may be tender when palpated. Consider acute peripheral arterial occlusion in patients at risk who have sudden pain out of proportion to physical findings. Diagnosis is clinical. Immediate angiography is required to confirm location of the occlusion, identify collateral flow, and guide therapy. 