Peripheral Arterial Embolism

In 134 major peripheral emboli involving 160 limbs in 114 patients, the limb survival rate was 85% and the hospital mortality rate was 30%. Embolectomy was performed for all nongangrenous limbs (82) with persistently severe ischemia. Limb survival was 92% when embolectomy was done within the first 12 hours (after embolism), 82% in the 12-to 48-hour period, and 70% in the 2- to 7-day period. Mitral commissurotomy and auricular appendectomy were performed on 24 patients with peripheral embolism; except for four emboli during commissurotomy, no further embolization and only one death have occurred. In the absence of gangrene, prompt embolectomy should be performed on limbs which show persistent signs of severe ischemia resistant to conservative therapy. If intensive medical and surgical attack does not eliminate the source of the embolus, long-term anticoagulation therapy is indicated.