J Med Assoc Thai 2011; 94 (12):1457

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Chronic Arterial Embolism of the Lower Extremities: An Unusual Etiology of Critical Limb Ischemia
Ruangsetakit C Mail, Chinsakchai K , Wongwanit C , Sermsathanasawadi N , Mutirangura P

Background: Chronic arterial embolism of the lower extremities, the unusual cause of critical limb ischemia (CLI), is not well
recognized in the medical practice.

Objective: To study the clinical problem of chronic arterial embolism in the aspects of the clinical characteristics and
treatment outcomes.

Material and Method: Between January 2000 and December 2004, 411 consecutive patients with chronic limb ischemia,
including 16 (3.8%) patients with chronic arterial embolism were included in the present study. The diagnosis of chronic
arterial embolism was confirmed by angiography, operative finding, and histopathology of amputated specimen. The clinical
characteristics and management outcomes were recorded and analyzed.

Results: Of the 16 patients with chronic arterial embolism, the mean duration of clinical manifestation was 2.4 months (range,
1-6). Femoral artery was the most common site of arterial occlusion (63.1%). Atrial fibrillation was the most common clinical
risk factor (25.0%). Of the 14 patients (87.5%) suffering from CLI, nine patients (56.25%) underwent the various types of
revascularization. In five patients (31.25%), the authors could not perform revascularization due to the fibrotic arteries.
Successful limb salvage and disappearance of rest pain with complete healing of ulcer in patients with CLI were only 50%.
One patient (6.25%) expired after major amputation.

Conclusion: Chronic arterial embolism of the lower extremities is the unusual cause of CLI with a high rate of major
amputation. Early detection and appropriate management of arterial embolism at the initial stage may reduce this serious
vascular problem.

Keywords: Chronic arterial embolism, Critical limb ischemia Major amputation, Lower extremities

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