Clinical differentiation between acute arterial embolism and acute arterial thrombosis of the lower extremities.
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 clinicalfactors significant for the differentiation between acute arterial embolism and acute arterial thrombosis in acute lower extremity ischemia.


METHODS
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.


CONCLUSIONS
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.
Mutirangura
Pramook
P
Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. pramook_siriraj@hotmail.com
Ruangsetakit
Chanean
C
Wongwanit
Chumpol
C
Sermsathanasawadi
Nuttawut
N
Chinsakchai
Khamin
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004617:Embolism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011674:Pulse; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology