Peripheral arterial embolism. A 20 year review.

Two hundred and forty eight peripheral arterial emboli occurring in 221 patients during a period of 20 years have been retrospectively reviewed. Best results are seen following early surgery with the balloon catheter but, in the clinical absence of tissue necrosis, late embolectomy is worthwhile. Atrial fibrillation and post-myocardial thrombus are the major sources of emboli, but tumour and septic emboli do occur and histological and bacteriological examination of retrieved material is essential. Patients who have sustained myocardial infarction have an increased risk of embolism in the first two weeks and despite modern therapy its incidence remains unchanged. Distinguishing true embolism from acute arterial thrombosis is a continuing problem and different surgical regimes for the two conditions are discussed. Embolectomy following anticoagulation has a high limb salvage rate and a low mortality; anti-coagulation as an adjuvant to surgery also improves prognosis for these patients who have lower amputation rates than those not anticoagulated.