Peripheral Arterial Embolism Research Articles

Treatment of Acute Coronary Occlusion

The diagnosis of acute coronary occlusion has been facilitated and its treatment improved. At the onset of the attack the electrocardiogram may be normal or show only slight changes. The major therapeutic advances include oxygen administration, a low calorie diet, the judicious use of digitalis and quinidine, the avoidance of such drugs as Adrenalin and nitroglycerin, and the employment of anticoagulant and pressor drugs. Therapy must be individualized, particularly in reference to the time chair treatment is begun, the time of ambulation, and the time for returning to work. The majority of patients can be treated at home. The pain which ushers in the attack should be relieved immediately. For this purpose, morphine is most efficacious. Nitroglycerin is not effective, and may be dangerous. The patient's anxiety must be allayed; he should be reassured that he, like the vast majority of patients, will make a good recovery and resume a full, productive life. Indiscriminate prolonged bed-rest for all patients is inadvisable. The period of bed-rest is determined by the physical and psychic state of each patient. Some mild cases are permitted to be in a chair on the second or third day; others, after a week. Early chair treatment has definite advantages. In the average mild case, the patient begins to walk during the fourth week. The routine use of anticoagulants is unnecessary. They should be employed in patients with heart failure or shock, and in those who develop peripheral phlebitis, peripheral arterial embolism, or pulmonary embolism. When anticoagulants are administered, the patient should be under close supervision. We believe that anticoagulants, administered during the premonitory phase of coronary thrombosis, are inefficacious; they neither prevent nor hasten the progress of the thrombosis. Anticoagulants are contraindicated in patients with a history of bleeding tendency, ulcerative colitis, peptic ulcer, renal or hepatic disease, or a cerebrovascular accident. It is important to differentiate coronary occlusion from non-specific pericarditis, since anticoagulants appear to be harmful in this condition. The electrocardiogram should not be used as a criterion for determining the progress of the patient and the time when he may sit up, begin to walk, or return to work. Neither should undue reliance be placed upon the sedimentation rate as a guiding factor in treatment. The treatment of heart failure in coronary occlusion is the same as if coronary occlusion were not present, but special care is necessary to prevent digitalis intoxication. A low calorie diet is important, for it diminishes the work of the heart, prevents gastrocardiac reflexes, and reduces weight in the obese. Constipation and distention must be prevented. Cold milk and fruit juices should be avoided and laxatives used. Nausea and vomiting are benefited by the oral or intramuscular administration of anti-motion sickness drugs. Early treatment of shock is essential. The vasopressor drugs are helpful, if administered early. If congestive failure is a factor, strophanthin or digitalis should be given. Pulmonary edema requires immediate treatment with morphine. If necessary, aminophylline, strophanthin, mercurials, oxygen under pressure, and rotating tourniquets or phlebotomy are employed. The inhalation of alcohol vapor is occasionally efficacious. Arrhythmias occur frequently and often remit. The indications for the treatment of each type are discussed and the details outlined. Quinidine is not used routinely. Hiccough may be a serious problem. Reassurance of the patient is most important. Adequate sedation should be used. Numerous successful therapeutic measures are available. Cortisone and ACTH are not efficacious in coronary occlusion. Antibiotics are administered if pulmonary congestion or signs of congestive heart failure are present, or if the temperature is above 102° F. Whiskey should not be given in acute coronary occlusion, since it may increase the pulse rate. Smoking should be prohibited. The prognosis in coronary occlusion has greatly improved during the past 30 years. In private practice, the mortality rate during the first attack is now five per cent or less. Most patients can be rehabilitated within two or three months. The vast majority makes a fair or good recovery, more than half make an excellent functional recovery. Four out of five return to work.

Peripheral arterial embolism.

Peripheral arterial embolism.

Continuous differential spinal anesthesia after femoral artery embolectomy.

Despite great strides made in the field of cardiovascular surgery during the past decade, the problems posed by peripheral arterial emboli remain largely unsolved, since the emboli tend to be multiple and are often fatal. Bull has classified five possible sites of origin of peripheral arterial emboli: (1) a central artery, such as the aorta, (2) the left side of the heart, (3) pulmonary veins, (4) the right side of the heart, and (5) systemic veins. The last two sites of origin postulate the presence of a patent foramen ovale. Although emboli may originate from any of these five locations, the most frequent site of origin is the left side of the heart. The location of mural thrombi and the incidence of arterial embolization vary with the type of heart disease present. Garvin 2 has reported a 67% incidence of mural thrombi in patients with coronary thrombosis and myo- cardial

Peripheral arterial embolism after myocardial infarction: occurrence in unsuspected cases and ambulatory patients.

Primarily because of the established psychological and physiological abnormalities that follow prolonged bed rest, early ambulation after acute myocardial infarction has been recommended by several authors. 1 It has been the clinical impression of one of us (G. de T.) that peripheral arterial emboli occur more frequently in the presence of early ambulation, especially when the coronary occlusion is unsuspected. This paper reports a small group of cases in which massive arterial emboli occurred while the patients were ambulatory. That thromboembolic phenomena occur commonly after acute myocardial infarction has been well established. Hellerstein and Martin 2 found this complication to be the major cause of death in 14% and a contributing cause of death in another 15% of 160 post-mortem examinations after myocardial infarction. In a review of the literature up to 1947, they found the lung to be the organ most frequently involved (23.5%) and the extremities the least

Femoral and iliac artery embolectomy; critical review of cases at Cook County Hospital from 1946 to 1951.

Since Labey1(1911) and Key2(1912) established embolectomy as a surgical procedure, occasional reports on the results of treatment of peripheral arterial embolism have appeared in the literature; in general these have favored surgical over nonsurgical treatment. However, in any hospital embolectomy is an uncommon procedure, and the reports of small series of cases, involving a particular artery, are difficult to evaluate because of the many variable factors that affect the immediate and final results. Recently we observed several cases of unexpected failure of femoral artery embolectomy despite immediate good results following removal of the embolus, and it was decided to review and analyze critically all cases of embolectomy at the Cook County Hospital within the previous five years. The purpose of this report is to present the end results of femoral and iliac artery embolectomies obtained at Cook County Hospital, and to compare the results with those

A BULLET EMBOLUS TO THE LEFT FEMORAL ARTERY FOLLOWING A THORACIC GUNSHOT WOUND: Probable Entrance Through Thoracic Aorta Case Report and Résumé of Peripheral Arterial Bullet Emboli

A BULLET EMBOLUS TO THE LEFT FEMORAL ARTERY FOLLOWING A THORACIC GUNSHOT WOUND: Probable Entrance Through Thoracic Aorta Case Report and Résumé of Peripheral Arterial Bullet Emboli

Peripheral arterial embolism.

Peripheral arterial embolism.

RESECTION OF THE LEFT AURICULAR APPENDIX

A therapeutic problem which remains unsolved is the one pertaining to recurrent arterial emboli. Once a peripheral embolus has occurred there is a high incidence of recurrence. Unfortunately, all too frequently the recurrent embolus is fatal, commonly involving one of the cerebral arteries.1As Jefferson so aptly stated2: In the nature of things a very high percentage of successes is unlikely ever to be attained, for emboli are apt to be multiple and further infarction will sometimes carry off the patient in whom a local success has been won. Since a thrombus is the precursor of every arterial embolus, the ideal prophylaxis for recurrent arterial emboli should be the removal of the thrombus together with its site of origin. Rheumatic mitral stenosis is one of the commonest causes of a peripheral arterial embolus, an embolus occurring in approximately 45 per cent of the cases.1bIn this disease the

Peripheral arterial embolism: Brachial embolism successfully treated

1. 1. The recent literature on peripheral embolism has been reviewed with statistics on various methods and results in treatment. 2. 2. The technical details of the treatment of this condition have been outlined and discussed. 3. 3. A case report of a patient showing complete brachial arterial occlusion has been presented. This patient was successfully treated.

EMBOLISM OF THE PERIPHERAL ARTERIES

Portis and Roth1recently reviewed the literature on embolectomy of the peripheral arteries and stated that only 131 cases had been reported. Four months earlier, however, Pearse2cited 296 cases which had been reported in the literature to July 1932. All articles on this subject imply that the authors are in agreement with the commonly accepted opinion, that when gangrene results from the occlusion of large vessels, the resulting gangrene, without operation, is fatal. Respect, however, has grown for the collateral circulation, especially in those portions of the body where end arteries have been said to exist. Case 1 is reported to demonstrate the fact that a fatal outcome is not always the result of a peripheral arterial embolism without embolectomy. This statement does not detract from the correctness of the conclusion of Key3and others4that in all threatening cases operation should be done. It