Arterial embolism in patients with cardiac disease

ABSTRACT

To define the pattern of aetiological factors and problems in management 29 cardiac patients with 40 acutely ischaemic limbs due to arterial embolism were studied. The mean age was 53 years [range 25-100]. The male to female ratio was 1.2 1; and 13 patients were Saudi nationals [44.8%]. There was a delay in management in 18 patients [62%], as they presented after more than 8 h of onset of the ischaemia. Lower limbs were affected in 26 patients [89.7%]. While rheumatic valvular heart disease was found to be the commonest aetiological disease in the non-Saudi patients, atherosclerotic coronary heart disease was encountered more frequently in Saudi patients. Emboli occluded a large artery in 22 patients [75.9%]; four of them were saddle aortic emboli. Embolectomy was considered the treatment of choice and performed on 33 limbs [82.5%] out of the 40 limbs treated, while heparin therapy only was used in treating four limbs [10%]. Seven limbs were amputated, three primary and four after embolectomy. Five of our patients [17.2%] expired and death was associated with a delayed, large peripheral embolism and myocardial ischaemia. In order to increase the chances of saving limbs, early referral of cases is highly recommended, followed by aggressive cardiac and surgical management. Whenever possible, the latter should be performed in vascular units