Risk Factors: ACUTE ARTERIAL OCCLUSION

age
smoking An arterial occlusion occurs when there is a complete or
diabetes partial blockage of an artery. It can reduce or even stop the
obesity flow of oxygen-rich blood to downstream vital tissues like
sedentary lifestyle the heart, brain, or extremities.
family history of vascular disease,
high cholesterol  atrial fibrillation  atherosclerosis
high blood pressure  myocardial infarction  Iatrogenic injury
 infective endocarditis  Rupture and thrombosis of an atherosclerotic plaque
 chronic heart failure  Embolus from the heart or thoracic or abdominal
aorta

Arterial emboli develop in the chambers of the heart as a result of atrial fibrillation, myocardial Platelet-rich thrombus formation over a ruptured atherosclerotic plaque
infarction, infective endocarditis, or chronic heart failure.

Thrombi become detached and are carried from the left side of the heart into the arterial system Damaged arterial wall, generally as a result of atherosclerosis

Thrombi become lodged in and obstruct an artery that is smaller than the embolus. Cessation of blood flow

Blockage progresses distal and proximal to the site of the obstruction.

The embolus can fragment or break apart, resulting in occlusion of distal vessels.
 Pharmacologic Management:
IV anticoagulation with heparin
Arterial thrombolytic medications
Fibrin-specific thrombolytic medications

Lab and Diagnostic Procedures:

Physical exam
Ankle-brachial index (ABI)
Ultrasound
Angiography
Blood tests

Occlusion of distal vessels

 Extremities have poor collateral flow

Pain Pallor Pulselessness Paresthesia Poikilothermia (coldness) Paralysis

Complications:
(PA): Upon inspection, distal extremities are pale in appearance.
Compartment syndrome
(PA): Upon palpation, the skin integument is cold to touch
Amputation
(Nd): Ineffective peripheral tissue perfusion related to impaired arterial circulation
Necrosis and gangrene
(N): Submit patient to diagnostic testing as indicated.
Bleeding
(N): Check for optimal fluid balance. Administer IV fluids as ordered.
Stroke
(N): Note urine output.
Myocardial infarction
(M): Administer nitroglycerin (NTG) sublingually for complaints of angina. Maintain oxygen
Death
therapy as ordered.

Surgical Management:
Endovascular Management:
-Emergency embolectomy
-Percutaneous mechanical thrombectomy

Prognosis: Acute arterial occlusion has high morbidity and mortality. The outcomes for patients with an acutely ischemic limb due to arterial occlusion are
guarded. Even if the limb is salvaged, these patients have other comorbidities, which can lead to a heart attack, renal failure, stroke, or wound infection. Unless
an interprofessional team is involved, the mortality for these individuals remains high. Expert opinion is highly recommended when these patients present to the
emergency room because the earlier the comorbidity is managed, the lower the risk of complications