In acute arterial embolism a clot, most often from the heart in atrial fibrillation, travels and suddenly blocks an artery, usually in a leg. Without blood flow the limb can die within hours, so fast recognition and reopening the artery save the limb.
Key symptoms
- Sudden, severe pain in the arm or leg
- Cold, pale limb
- Numbness or tingling
- Weakness or inability to move the limb
- Recent palpitations or known atrial fibrillation
What you find on exam
- The 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (coldness)
- Absent pulses below the blockage, compared with the other side
- Slow capillary refill and mottled skin
- Sensory and motor check to grade how threatened the limb is
- Irregular pulse or murmur pointing to a cardiac source
Tests
- Handheld Doppler at the ankle for arterial and venous signals
- CT angiography to locate the clot, if it does not delay surgery
- ECG and echocardiogram to find the source
- Blood count, clotting tests, kidney function, creatine kinase, lactate
Treatment basics
- Start IV unfractionated heparin right away
- Urgent vascular surgery consult
- Reopen the artery: surgical embolectomy or catheter-directed thrombolysis
- After flow returns, watch for compartment syndrome and high potassium
- Long-term anticoagulation if the source is atrial fibrillation
Red flags
- Loss of sensation or movement in the limb
- Tense, painful calf after flow is restored
- No Doppler signal in the arteries or veins of the foot
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.