P1: SBT
0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8
158 Arterial Embolus■Erroneous attribution of weakness and paresthesia to stroke or other
neuro cause is most frequent reason for limb loss after arterial embo-
lus
management
What to Do First
■Intravenous heparin
➣Give regardless of arterial embolus or thrombosis
➣Prevents propagation of thrombus
■Hydration
➣Prevent intravascular depletion and prerenal azotemia
➣Alkalinize urine with IV sodium bicarbonate (prevent myoglobin
precipitation and acute tubular necrosis)specific therapy
Indications for Treatment
■All patients require specific therapy to avoid limb lossSurgical Embolectomy
■Treatment of choice for most extremity emboli
■Quickest way to restore flow (important if there are sensory or motor
changes indicative of advanced ischemia)
■Requires anesthesia and associated risk
■Complications
■Severe hyperkalemia upon reperfusion (cardiac arrest)
■Compartment syndrome after reperfusion (fasciotomy if preopera-
tive ischemia > 4 hrs)
■Amputation (15%)
■Related to duration and level of ischemia
■Mortality (7–34%)
■Renal failure (10%)
■Contraindications (Relative)
■Systemic illness too severe to tolerate anesthesia (embolectomy can
be done under local anesthesia with sedation)Thrombolytic Therapy
■Avoids anesthesia, stress and blood loss of surgery
■Allows lysis of thrombus in small vessels and branches
■Requires 24–48 hours for restoration of flow
■Risk of bleeding (puncture site, intracranial)
■Complications
➣Similar to surgical embolectomy