The femoropopliteal segment as a source of peripheral atheroembolism.
The concept of atheromatous embolisation from ulcerated plaques in non-aneurysmal arteries is well recognised but little attention has been paid to lesions in arteries below the inguinal ligament as a source of emboli. Twenty eight of 42 patients (66%) who presented with atheroembolism to the lower limbs had an embolic source in the femoropopliteal segment, with only a third with an identifiable source lesion in the aorta or iliac vessels. A characteristic clinical presentation, combined with a typical appearance on arteriography, usually allows a confident diagnosis to be made, yet many of these patients still have their ischaemic symptoms and signs wrongly attributed to occlusive disease. Successful management depends on early recognition and correction of the source lesion. The treatment of choice is a bypass procedure with appropriate vessel ligation. The majority of ischaemic lesions recover, or the damage is limited to minor digital amputations which will heal primarily. Surgical correction is successful in preventing further embolic episodes.
Epsom District Hospital, Surrey.
R J
RJ
McFarland
R S
RS
Taylor
A B
AB
Woodyer
J B
JB
Eastwood
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications*; D004617:Embolism / Q000209:etiology*; D005260:Female; D005263:Femoral Artery; D005534:Foot Diseases / Q000209:etiology*; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D014034:Toes / Q000473:pathology