Journal of Vascular and Endovascular Therapy

Commentary

Arterial embolism is an abrupt cessation of blood flow to an organ or body part caused by an embolus sticking to the arterial wall and obstructing blood flow, with a blood clot being the most common type of embolus (thromboembolism). A pulmonary embolism can also be categorised as an arterial embolism, since the clot follows the pulmonary artery, which carries deoxygenated blood away from the heart. Because the embolus occurs in veins, pulmonary embolism is usually classed as a type of venous embolism. The most common cause of infarction is arterial embolism (which may also be caused by e.g. arterial compression, rupture or pathological vasoconstriction).

Symptoms and signs

Depending on the size of the embolus and how much it inhibits blood flow, symptoms may appear immediately or slowly. Embolization symptoms vary depending on the organ involved, however they typically include:

• Aches and pains in the affected body part

• Decreased organ function over a short period of time.

Infarction of the damaged tissue is linked to later symptoms. This could result in diminished organ function for the rest of your life. Myocardial infarction symptoms include chest pain, dyspnea, diaphoresis (excessive sweating), weakness, light-headedness, nausea, vomiting, and palpitations, to name a few. Coldness, diminished or absent pulse beyond the site of blockage, pain, muscle spasm, numbness and tingling, pallor, muscle weakness, possibly to the grade of paralysis in the afflicted limb are all symptoms of limb infarction.

Factors that are at risk

Disturbed blood flow (such as in atrial fibrillation and mitral stenosis), injury or damage to an artery wall, and hypercoagulability are all risk factors for thromboembolism, the most common cause of arterial embolism (such as increased platelet count). Mitral stenosis increases the chances of emboli developing in the heart, which can travel to the brain and cause a stroke. Endocarditis raises the risk of thromboembolism due to a combination of the variables listed above.

Atherosclerosis of the aorta and other big blood arteries is a common risk factor for both thromboembolism and cholesterol embolism, according to the American Heart Association. These types have a lot of impact on their legs and feet. As a result, the same risk factors that cause atherosclerosis also cause arterial embolization:

• Advancing years

• Smoking cigarettes

• Elevated blood pressure (hypertension)

• Obesity

• Hyperlipidemia (high cholesterol, high triglycerides, increased lipoprotein (a) or apolipoprotein B, or low HDL cholesterol levels)

• Diabetes mellitus (diabetes mellitus) (diabetes mell

• A sedentary way of life

• Stress

Paradoxical embolization occurs when a clot in a vein enters the right side of the heart and travels through a hole into the left side due to a septal defect in the heart. The clot may then go to an artery, resulting in arterial embolisation.

Pathophysiology

An arterial embolism occurs when one or more emboli become lodged in an artery, limiting blood flow and causing ischemia, which can lead to infarction and tissue death (necrosis). To compensate for the loss of arterial flow, people with arterial thrombosis or embolism establish collateral circulation. However, adequate collateral circulation takes longer to develop, rendering damaged areas more vulnerable to rapid embolisation than, say, progressive blockage as seen in atherosclerosis.

Diagnosis

The following tests may be used to identify if there is an underlying cause for thrombosis or embolism, as well as to confirm the presence of the obstruction:

• Doppler ultrasound, particularly duplex ultrasound. It may also include a transcranial doppler examination of the brain's arteries.

• Echocardiography, which may include more sophisticated procedures like Transesophageal echocardiography (TEE) or myocardial contrast echocardiography (MCE) to diagnose myocardial infarction.

• Arteriography of the diseased limb or organ.

• When the use of radiopaque contrast material must be kept to a minimum, digital subtraction angiography is a good option.

• MRI (magnetic resonance imaging)

• Blood tests for cardiac-specific troponin T and/or troponin I, myoglobins, and creatine kinase iso enzymes, as well as myoglobins and creatine kinase iso enzymes. These are signs of a heart embolization that has produced a myocardial infarction. In additional embolization sites, myoglobins and creatine kinase levels are likewise high in the blood.

• Blood cultures can be used to identify the organism that is causing the infection

• Electrocardiography (ECG) for myocardial infarction detection

• Angio scopy, which involves inserting a flexible fiber optic catheter straight into an artery