Sudden occlusion of an artery (carrying oxygen-rich blood from the heart to the periphery) gives rise to an acute arterial occlusion. This is most commonly due to thrombi (blood clots), carried by the blood stream either from the heart or another part of the body as a so-called embolus, or local thrombus formation following injury to the vessel wall, by underlying calcified plaques, for instance. Rarer causes include so-called paradoxical emboli (passage of a blood clot from the venous to the arterial system through a congenital defect in the cardiac septum), congenital coagulation disorders, cancer, etc.
An embolus arises in the heart mostly in cases with underlying atrial fibrillation. This may then occlude any peripheral vessel, from cerebral arteries (with risk of stroke) to intestinal arteries (with risk of reduced supply to the intestine and tissue death of parts of the intestine) and the arm or leg arteries (with risk of amputation). Local thrombi may also develop in all these arteries.
Time is a critical factor in acute vascular occlusion, since the longer the absence of adequate blood supply to dependent tissue , the higher the risk of irreversible damage.
These include open surgery and percutaneous interventional therapy:
Open surgical procedures include the so-called Fogarty’s thrombectomy, especially used for occlusion of arm and leg arteries. The procedure is performed under general anesthesia with exposure of an easily accessible vessel (usually an artery in the groin). The vessel is then opened by an incision and a Fogarty catheter (named after the person who first described it) introduced into the vessel and negotiated across the occluded segment. This catheter is provided with a balloon at its front end which may be filled by a syringe at its rear end. Once the catheter negotiates the thrombus, the balloon is filled and is withdrawn together with the blood clot. Contrast medium and x-rays are then used to check for the presence of any residual thrombus in the blood vessel.
Various interventional techniques may be alternatively employed. An easily accessible vessel is thereby punctured through the skin with a needle, over which wires or a catheter are introduced. Local anesthesia usually suffices for the procedure. The blood clot can then be suctioned out (aspiration thrombectomy) or dissolved by medication allowed to run into the vessel for several hours (lysis).
The treatment strategy best suited for your condition will be decided by your treating physician, and will depend on your general health and the site of occlusion, amongst others.
Preparation and aftercare
You cannot usually be prepared for this as a patient since the disease is sudden in onset.
You will be administered blood thinners in hospital after being treated for a vascular occlusion. The source of the embolus ( in case this was not a local event) will also be searched for; investigations such as an ultrasound of the heart, blood tests or computer tomography and other tests may be necessary. Further therapy will be discussed with you depending on the situation. If you are found to be have atrial fibrillation (the most common cause), continuing therapy with blood thinners is necessary in most cases. Evaluating the cause is important in order to prevent recurrence of acute vascular occlusion.