Femoral Embolism

Question 1

What is it?

Answer 1

Acute limb ischaemia due to formation of a thrombus in the proximal leg

Question 2

Is this an emergency?

Answer 2

Yes because there has not been time to develop a collateral cirulation

Question 3

What causes it?

Answer 3

1. Thrombosis usually from atherosclerotic plaque rupture
2. Embolus e.g from Atria
3. Trauma
4. Graft/angioplasty occlusion
5. Raynauds
6. Compartment syndrome
7. Congenital e.g Aortic Hypoplasia

Question 4

Is it common?

Answer 4

Not really, mostly caused by thrombus formation

Question 5

Risk factors (4)

Answer 5

Atherosclerosis, thrombophilia, Vascular Surgery, Atrial Fibrillation

Question 6

Signs and Symptoms (7)

Answer 6

Pale, pulseless, painful, paralysed, paraesthesia, perishingly cold, fixed mottling implies irreversibility

Question 7

Differentials (4)

Answer 7

Gout, cellulitis, PAD, arterial dissection

Question 8

What bloods would you do? (9)

Answer 8

D-dimer, FBC, CRP, U&E, LFT, Clotting, Lipids, Glucose, Thrombophilia screen

Question 9

Other investigations (7)

Answer 9

Doppler, ultrasound, arteriography, ECG, ECHO, Aortic ultrasound, Popliteal and Femoral Artery ultrasound

Question 10

What is the treatment? (8)

Answer 10

Urgent admission, tissue plasminogen activator (alteplase) if thrombosis, angioplasty or bypass surgery, surgical embolectomy if embolus, LMWH anticoagulation, long term warfarin/NOAC, control other CVD risk factors

Question 11

Complications (4)

Answer 11

Reperfusion injury, compartment syndrome, leakage from damaged cells can cause acidosis, peripheral nerve injury can cause chronic pain

Question 12

Is there a good prognosis?

Answer 12

Mortality is 22%, Amputation is 16%, Complete occlusion of the artery can cause extesnive necrosis if untreated in 6 hours