Acute Arterial Occlusion

What is acute arterial occlusion?

Acute arterial occlusion is a sudden blockage or closing of one of your peripheral arteries that interrupts blood flow. Healthcare providers also call this condition acute limb ischemia. “Ischemia” means part of your body isn’t receiving enough oxygen-rich blood. When this happens, your tissues quickly become damaged and may soon die.

Acute arterial occlusion may affect any of your limbs (legs or arms). But it usually affects your legs, and it’s often a severe complication of peripheral artery disease (PAD).

This condition is a life-threatening medical emergency that needs immediate medical attention. Without prompt care, you have a higher risk of losing your limb or dying.

What is the difference between acute arterial occlusion and chronic arterial disease?

Acute arterial occlusion refers to symptoms that start and quickly get worse within a two-week timeframe. You have pain in your limb that doesn’t go away when you rest. You need medical help and treatment right away.

Chronic arterial disease (also called PAD) has symptoms that develop more gradually. Intermittent claudication is a typical symptom you may experience for a while. This cramping or aching feeling in your legs begins when you exercise and stops after you rest for a few minutes. PAD may lead to acute arterial occlusion.

How common is acute arterial occlusion?

Acute arterial occlusion affects about 1 in 4,500 people. There are no sex-based differences. The median age of diagnosis is 75.

What are the symptoms of acute arterial occlusion?

Symptoms of acute arterial occlusion appear in the affected limb (usually your leg). Healthcare providers refer to the symptoms as the “six Ps.”

1. Pain: Severe pain is a common symptom and usually the first.
2. Pallor: Your skin looks very pale.
3. Pulse deficit: Your pulse is weak or missing.
4. Poikilothermia (sometimes called “polar sensation”): Your skin feels cool to the touch.
5. Paresthesia: You have a “pins and needles” feeling.
6. Paralysis: You can’t feel or move your limb.

An embolism causes sudden and severe symptoms. In other cases, symptoms may show up over several hours or days. The longer your limb goes without oxygen, the more your symptoms will progress. Pain turns into a “pins and needles” feeling, which finally turns into paralysis.

What causes acute arterial occlusion?

The most common cause of acute arterial occlusion is a blood clot (thrombus) in one of your arteries. A blood clot can form anywhere in your body, but it’s most common in your legs. It’s especially common in your superficial femoral artery, which supplies blood to your lower leg.

Blood clots are more likely to form in an area where you have:

• A stent or stent graft: A device that helps your blood flow better but sometimes triggers clots.
• An aneurysm: A weakened, bulging section of your artery.
• Plaque: A fatty substance that builds up in your arteries when you have atherosclerosis.
• Traumatic injury: Direct damage to your artery, such as a stab wound.

A blood clot may also form in one part of your body and then travel through your bloodstream. This is called an embolus. An embolus can get stuck in one of your arteries and block blood flow. It’s most likely to get stuck in an artery with lots of plaque buildup or at the intersection of two arteries.

The embolus may originate in many different locations. Sometimes, it begins in your heart, including your:

• Left ventricle: This is the lower left chamber of your heart that pumps blood out to your body through your aorta. Blood clots may form in your left ventricle as a complication of a heart attack (up to three months afterward).
• Left or right atrium: These are the top two chambers of your heart. People with atrial fibrillation have a higher risk of blood clots forming here.
• Prosthetic heart valves: Blood clots sometimes form on replacement valves in your heart.

An embolus may also begin in another artery. This is an arterial-to-arterial embolization. It means the blood clot formed in one artery and then traveled to another artery.

What are the risk factors for acute arterial occlusion?

Some medical conditions raise your risk of developing acute arterial occlusion. These include:

• Atrial fibrillation.
• Diabetes.
• High cholesterol.
• High blood pressure.
• Obesity.
• Peripheral artery disease (PAD).
• Recent heart attack.
• Systolic heart failure.

Other risk factors include:

• Age (50 or older).
• Family history of vascular disease.
• IV drug use.
• Lack of exercise.
• Smoking and tobacco use.

How is acute arterial occlusion diagnosed?

Diagnosis often begins in an emergency room and includes:

• Physical exam: Your healthcare provider carefully checks your limb. They feel your skin and check your pulse at many different points. They also look for visible signs of peripheral artery disease (PAD), like ulcers on your skin.
• Medical history: Your provider checks your medical history to help find the cause of the occlusion. It’s important for your provider to learn the cause and source of the blockage in order to treat it properly. For instance, atrial fibrillation raises your risk of an embolism, while PAD raises your risk of a thrombus.
• Testing: Your provider may perform a vascular ultrasound. They’ll use a hand-held Doppler ultrasound device to check blood flow in your limb. Your provider may also perform a computed tomography angiogram (CTA). This is like a coronary CTA but focuses on your affected limb. Your provider may also perform peripheral angiography, a procedure that uses X-ray contrast to look at the blood vessels in your legs.
• Vascular surgery consultation: A vascular surgeon evaluates your condition and decides the best plan.

Acute arterial occlusion is a medical emergency that needs a fast and accurate diagnosis. Every minute and every hour make a huge difference in your outcome. An occlusion may cause permanent damage to your limb within four to six hours. That’s why it’s important to seek emergency care immediately if you have symptoms.

What is the treatment for acute arterial occlusion?

Treatment depends on the type of blockage you have, where it’s located and your overall health. Acute arterial occlusion is life-threatening. So, the main goal of treatment is to save your life. Related goals include:

• Restore blood flow to your limb.
• Save your limb.
• Prevent more blood clots from forming.

Arterial occlusion often requires a surgery or minimally invasive procedure. A vascular surgeon will evaluate your condition and decide which surgery or procedure you need. You may need more than one. Options include:

• Catheter-directed thrombolysis: Uses medication to dissolve your clot.
• Endarterectomy: Removes plaque from your artery.
• Peripheral artery bypass surgery: Creates a new path for your blood to flow around the blockage. This is similar to a coronary artery bypass.
• Thrombectomy: Removes a blood clot from your artery.

Severe cases require amputation. This happens if your limb is too damaged to repair. About 1 in 4 people who survive acute arterial occlusion need an amputation.

As your care team prepares you for surgery, they may give you:

• Heparin or another drug to prevent more blood clots.
• IV fluids.
• Pain medication.

How can I prevent acute arterial occlusion?

You may not be able to prevent acute arterial occlusion. But some steps you can take to lower your risks include:

• Don’t smoke or use any tobacco products.
• Exercise. Ask your healthcare provider which types of exercises are best for you.
• Keep a healthy weight. Talk with your provider about your ideal range.
• Manage conditions including diabetes, high blood pressure and high cholesterol.

Visit your provider for yearly check-ups.

If you have PAD, follow your provider’s guidance on how to manage your condition. There’s no cure for PAD, but you can take steps to slow down its progression. This will help lower your risk of serious complications like acute arterial occlusion.

If you have atrial fibrillation or a history of blood clots, ask your provider if you should be on a blood thinner.

What should I expect as I recover from acute arterial occlusion?

If you have surgery, you’ll begin your recovery in the intensive care unit. Your healthcare provider will investigate the underlying cause of the occlusion to help prevent it from happening again. Your care team will also monitor you for complications, including:

• Compartment syndrome.
• Congestive heart failure.
• Heart attack.
• Kidney failure.
• Respiratory issues.
• Rhabdomyolysis.

Your provider will tell you if you need to take medications after your surgery. These include:

• Anticoagulants.
• Antiplatelet drugs.
• Statins.

Your provider will also provide you with detailed instructions on:

• How to care for yourself at home, including how to care for incisions or wounds.
• How to manage your medications.
• Restrictions related to physical activity and driving.
• When you should seek medical attention.
• When you should start exercising and what you should do.

What is the outlook for people who have acute arterial occlusion?

Outcomes vary widely from person to person. Acute arterial occlusion is often fatal. About 1 in 4 people don’t survive beyond one year. But with prompt treatment and ongoing medical care, you may be able to recover. Talk with your provider about your prognosis. If you need an amputation, your quality of life will change. But your healthcare team will help you adapt to these changes. Acute arterial occlusion is dangerous, and amputation may be the only way to save your life. Your provider may recommend physical therapy to help you regain your limb function and overall strength.

How do I take care of myself?

Life after treatment for acute arterial occlusion isn’t easy. You may feel weak or exhausted. You may also feel stressed or scared. But life is manageable with the help of your care team and your loved ones. Closely follow your healthcare provider’s guidance on how to take care of yourself when you’re back home.

Overall, it’s important to do whatever you can to support the health of your blood vessels and heart. General advice includes:

• Ask your provider what exercises are safe and helpful for you.
• Keep a weight that’s healthy for you.
• Stop smoking or using any tobacco products.
• Take your medications as prescribed.
• Visit your provider for annual check-ups and keep all of your follow-up appointments.
• Work with your provider to manage your blood pressure, blood sugar and cholesterol.

It’s also important to care for your mental and emotional health. Some tips include:

• Find a new hobby you enjoy doing that isn’t physically demanding.
• Join a support group for people with heart or vascular conditions.
• Meet with a counselor regularly.
• Spend time with family and friends.

When should I see my healthcare provider?

Your provider will tell you how often you should come in for appointments. Call your provider if you have any new or changing symptoms.

When should I go to the emergency room?

Call 911 or your local emergency number if you experience:

• Bleeding.
• Chest pain.
• Confusion or trouble thinking.
• Dizziness or balance problems.
• Fever.
• Pain, swelling or numbness in your limb.
• Pus or drainage from an incision site.
• Shortness of breath.

A note from Cleveland Clinic

Acute arterial occlusion is a life-threatening medical emergency. It’s essential to learn the symptoms and seek medical attention right away. Prompt care improves your chances of survival.

If this happens to a loved one, you might feel just as scared as they do. You might also feel powerless. But there’s actually a lot you can do. Stay involved in your loved one’s care, and talk with their healthcare providers. Help them at home as they recover, and assure them they’re not alone. And along the way, educate others in your life about this condition, its symptoms and its risk factors.