Clinical Differentiation Between Acute Arterial Embolism and Acute Arterial Thrombosis of the Lower Extremities
Pramook Mutirangura MD*, Chanean Ruangsetakit MD*, Chumpol Wongwanit MD*, Nuttawut Sermsathanasawadi MD*, Khamin Chinsakchai MD*
Affiliation : * Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The primary treatments of acute arterial embolism and acute arterial thrombosis are different.
The clinical differentiation of the two diseases at initial stage can provide the efficient treatment of acute limb
ischemia.
Objective : Identification of the clinical factors significant for the differentiation between acute arterial embolism
and acute arterial thrombosis in acute lower extremity ischemia.
Material and Method: A prospective study of the consecutive 120 patients with acute lower extremity ischemia
was carried out between January 2000 and December 2004. All clinical information was compared between
the proven acute arterial embolism and acute arterial thrombosis.
Results : Among 120 patients, 91 (75.8%) were with acute arterial embolism and 29 (24.2%) were with acute
arterial thrombosis. Normal peripheral pulse on the contralateral limb was more commonly found in patients
with acute arterial embolism than in patients with acute arterial thrombosis (71.4% vs. 31.0%, p < 0.001).
Atrial fibrillation was detected more in patients with acute arterial embolism than acute arterial thrombosis
(31.9% vs. 3.4%, p = 0.004). Mitral valve stenosis (12.1%) and previous arterial embolism (16.5%) were only
detected in patients with acute arterial embolism. On the other hand, patients with acute thrombosis had the
higher comorbidities such as diabetes mellitus (44.8% vs. 19.8%, p = 0.015), hypertension (55.2% vs. 27.5%,
p = 0.012), and hypercholesterolemia (37.9% vs. 6.6%, p < 0.001). Patients with acute arterial embolism had
more severe clinical manifestations such as immediately threatened ischemia (56.0% vs. 13.8%, p < 0.001)
and higher tendency of suffering from extensive limb gangrene (18.7% vs. 6.9%, p = 0.156). On the contrary,
patients with acute arterial thrombosis had the previous symptom of intermittent claudication (51.7% vs.
3.3%, p < 0.001) more than patients with acute arterial embolism.
Conclusion : The clinical factors significant for the differentiation between acute arterial embolism and acute
arterial thrombosis were the status of peripheral pulse on the contralateral limb, the clinical risk factors of the
two diseases, the previous arterial embolism, the clinical manifestation, and progression of ischemic status.
Keywords : Acute arterial embolism, Acute arterial thrombosis, Acute limb ischemia, Clinical differentiation, Lower extremity
