The document discusses acute arterial occlusion, which is defined as the sudden and rapid worsening of symptoms and signs within 14 days. It is caused by a thrombus forming on top of pre-existing arterial narrowing. Risk factors include dehydration, low blood pressure, unusual activity or posture, cancer, high blood viscosity, and blood clotting disorders. Treatment depends on whether the cause is an embolism or thrombosis, and may include clot removal, blood thinners, bypass surgery, or procedures to open the blocked artery. General management consists of stabilizing the patient and starting anticoagulation therapy, while definitive treatments range from medications alone to surgical or catheter-based interventions.

1. By:
Farah Adibah Kasmin
Undergraduate UiTM

2.  Definition: Sudden and rapid worsening symptoms and
signs (<14 days)
(ABC of Arterial and Venous Disease, BMJ. 2000 April 8; 320(7240): 991)
 It is caused by a thrombus superimposed on an
arteriosclerotic stenoses
(Clinical distinction of acute and acute on chronic leg ischaemia, Kauhanen P etc, Fourth Department of
Surgery, Helsinki University Central Hospital, Finland)
 Predisposing factors to acute thrombosis
1. Dehydration
2. Hypotension
3. Unusual posture or activity
4. Malignancy
5. Hyperviscosity
6. Thrombophilia

3. Clinical features Embolus Thrombosis
Complete (no
Severity Incomplete (collaterals)
collaterals)
Onset Seconds or minutes Hours or days
Limb affected Leg 3:1 arm Leg 10:1 arm
Embolic source Present (Ex: AF) Absent
Previous claudication Absent Present
Palpation of artery Soft, tender Hard, calcified
Bruits Absent Present
Contralateral leg
Present Absent
pulses
Diagnosis Clinical Angiography
Treatment Embolectomy, warfarin Medical, bypass, thrombolysis

4. Management
General
 Life threatening medical conditions
 Assess airway, breathing and circulation, and resuscitate as
required
 Oxygen to improve oxygen supply to leg
 Adequate analgesia:morphine with an anti-emetic
 Correct fluid & electrolyte imbalance
 Start anticoagulation: Bolus IV unfractionated heparin and infusion
 Catheterize and monitor input/output
Definitive
 Conservative : anticoagulation only
 Thrombolytic therapy- streptokinase, urokinase, rTPA
 Arterial Reconstruction- Bypass
 Endovascular- angioplasty, stents, aspiration devices
 Combination of the above