Arterial embolism is a sudden interruption of blood flow to an organ or body part due to an embolus adhering to the wall of an artery blocking the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmonary embolism is classified as arterial embolism as well, in the sense that the clot follows the pulmonary artery carrying deoxygenated blood away from the heart. However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins. Arterial embolism is the major cause of infarction (which may also be caused by e.g. arterial compression, rupture or pathological vasoconstriction).
Signs and symptoms
Symptoms may begin quickly or slowly depending on the size of the embolus and how much it blocks the blood flow. Symptoms of embolisation in an organ vary with the organ involved but commonly include: Pain in the involved body part Temporarily decreased organ function
Later symptoms are closely related to infarction of the affected tissue. This may cause permanently decreased organ function.
For example, symptoms of myocardial infarction mainly include chest pain, dyspnea, diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations.
Symptoms of limb infarction include coldness, decreased or no pulse beyond the site of blockage, pain, muscle spasm, numbness and tingling, pallor and muscle weakness, possibly to the grade of paralysis in the affected limb.
Commonly occluded sites
Arterial emboli often occur in the legs and feet. Some may occur in the brain, causing a stroke, or in the heart, causing a heart attack. Less common sites include the kidneys, intestines, and eyes.
Risk factors
Risk factors for thromboembolism, the major cause of arterial embolism, include disturbed blood flow (such as in atrial fibrillation and mitral stenosis), injury or damage to an artery wall, and hypercoagulability (such as increased platelet count). Mitral stenosis poses a high risk of forming emboli which may travel to the brain and cause stroke. Endocarditis increases the risk for thromboembolism, by a mixture of the factors above.
Atherosclerosis in the aorta and other large blood vessels is a common risk factor, both for thromboembolism and cholesterol embolism. The legs and feet are major impact sites for these types. Thus, risk factors for atherosclerosis are risk factors for arterial embolisation as well: advanced age cigarette smoking hypertension (high blood pressure) obesity hyperlipidemia, e.g. hypercholesterolemia, hypertriglyceridemia, elevated lipoprotein (a) or apolipoprotein B, or decreased levels of HDL cholesterol) diabetes mellitus Sedentary lifestyle stress
Other important risk factors for arterial embolism include: recent surgery (both for thromboembolism and air embolism) previous stroke or cardiovascular disease a history of long-term intravenous therapy (for air embolism) Bone fracture (for fat embolism)
A septal defect of the heart makes it possible for paradoxical embolization, which happens when a clot in a vein enters the right side of the heart and passes through a hole into the left side. The clot can then move to an artery and cause arterial embolisation.
Pathophysiology
An arterial embolism is caused by one or more emboli getting stuck in an artery and blocking blood flow, causing ischemia, possibly resulting in infarction with tissue death (necrosis). Individuals with arterial thrombosis or embolism often develop collateral circulation to compensate for the loss of arterial flow. However, it takes time for sufficient collateral circulation to develop, making affected areas more vulnerable for sudden occlusion by embolisation than for e.g. gradual occlusion as in atherosclerosis.
Materials
Arterial embolisms can consist of various materials, including: Thromboembolism – embolism of thrombus or blood clot. Cholesterol embolism - embolism of cholesterol, often from atherosclerotic plaque inside a vessel. Fat embolism – embolism of bone fracture or fat droplets. Air embolism (also known as a gas embolism) – embolism of air bubbles. Septic embolism – embolism of pus containing bacteria. Cancer embolism
In contrast, amniotic fluid embolism almost exclusively affects the venous side.
Diagnosis
In addition to evaluating the symptoms above, the health care provider may find decreased or no blood pressure in the arm or leg.