Lower-extremity arterial emboli from ulcerating atherosclerotic plaques
R. F. Kempczinski
Ten cases of lower-extremity emboli originated from proximal, ulcerated
atherosclerotic plaques. Two distinct clinical presentations were seen.
Embolization of cholesterol-rich debris was usually widespread and lodged
in terminal arteries, producing either focal digital ischemia or livedo
reticularis of the extremity. By contrast, thrombi arising from mural
erosions were larger and produced a picture indistinguishable from emboli
of cardiac origin. Biplanar aortography was essential in making the correct
diagnosis. Anticoagulation has not prevented recurrent embolization.
Endarterectomy or graft replacement of the diseased arterial segment is the
preferred method of treatment. Lumbar sympathectomy is a useful adjunct
when persistent cutaneous ischemia is present.
