Arterial Occlusion: Acute Treatment for Peripheral Arterial Disease

Arterial occlusion is essentially a systemic vascular disease of the arteries. As a result of atherosclerosis, arterial stenosis develops over time, eventually leading to complete occlusion of the vessel.

This results in a reduced supply of oxygen-rich arterial blood, leading to oxygen deprivation in the tissues supplied by the artery. Peripheral arterial disease (PAD) and coronary artery disease are typical examples of this condition.

In contrast, in the case of an acute arterial occlusion, the blood supply to the tissue supplied by the affected artery is interrupted, posing a risk of oxygen deprivation and tissue damage. Well-known examples include a heart attack, in which an artery in the heart’s coronary arteries becomes blocked, or a stroke, in which a blood vessel in the brain is blocked.

Such acute events are usually caused by blood clots (thrombi) that form, for example, as a result of deep vein thrombosis in the leg or cardiac arrhythmias (e.g., atrial fibrillation) and can then cause a stroke, a heart attack, or a pulmonary embolism by blocking an artery. These three events are life-threatening emergencies.

Illustration of a vascular occlusion © pankajstock123 #63446706 | AdobeStock

The arteries in the legs are frequently affected—medical professionals refer to this as peripheral arterial disease, or PAD for short. A characteristic symptom of PAD is a stabbing pain in the affected leg after walking a relatively short distance (= exertional pain) and an apparent recovery after a period of rest. These symptoms ultimately gave the condition its colloquial name—“window-shopping disease”—because, much like window shopping, short walks are interrupted by numerous breaks.

In addition, the arteries of the heart (= coronary arteries) can be affected, leading to the clinical picture of “chest tightness” (= coronary heart disease).

There are also arterial occlusive diseases affecting the brain, the eyes, and the kidneys (= renal artery stenosis).

Initially, arterial occlusions cause very few symptoms, which usually manifest during physical exertion. For example, peripheral arterial disease (PAD) causes pain during physical exertion; coronary heart disease causes “chest tightness” (angina pectoris) accompanied by shortness of breath and pain; and blockages in the renal arteries usually lead to an increase in blood pressure.

However, these slowly progressive occlusive diseases must be distinguished from an acute arterial occlusion, which is a medical emergency. This causes severe pain in the legs, absence of a pulse below the site of occlusion, and pale skin.

A heart attack, meanwhile, is characterized by pain, anxiety, and shortness of breath. In the case of a stroke, depending on the affected region of the brain, symptoms such as speech difficulties, facial and limb paralysis, dizziness, and severe headaches may occur.

Doctors obtain initial indications of an arterial occlusion from the patient’s medical history and physical examination, provided the patient is already exhibiting symptoms such as shortness of breath, pain on exertion, or chest tightness. The next step is imaging, primarily using ultrasound and Doppler ultrasound to visualize blood flow in the arteries.

If coronary artery involvement is suspected or if the patient has cardiac arrhythmias, an electrocardiogram (ECG) is performed. Angiography, magnetic resonance imaging (MRI), and computed tomography (CT) also enable comprehensive imaging, e.g., of the brain or heart.

While peripheral artery disease that is still in its early stages can generally be slowed by increasing physical activity, adopting a healthier diet, and avoiding nicotine and alcohol, an impending complete or already acute arterial occlusion requires inpatient care in a hospital.

The primary goal is to clear the arterial blockage as quickly as possible in order to restore blood flow to the tissue or organ. Medication typically involves heparinization, i.e., the use of anticoagulants to attempt to reopen the vessels.

In cases of high risk of a heart attack, such as with coronary heart disease, doctors attempt to place stents to widen the arteries and keep them open, or perform what is known as bypass surgery.

On the left, an impending vascular occlusion; on the right, dilation using a stent © crevis #89836026 | AdobeStock

In the latter procedure, the blocked section of the artery is bypassed using “alternative circulation pathways,” thereby redirecting blood flow to the heart muscle. However, without a subsequent change in diet and increased physical activity in daily life, peripheral arterial disease will eventually block these bypasses as well.

Vascular diseases such as peripheral arterial disease are treated by specialists in internal medicine, cardiology, and/or angiology (vascular medicine). 

What is an arterial occlusion?

An arterial occlusion is the complete or partial blockage of an artery, which interrupts blood flow. In the case of an acute arterial occlusion, the affected limb suddenly experiences reduced blood supply. This condition is classified as a serious circulatory disorder and requires prompt treatment.

What causes an acute arterial occlusion?

The most common cause of an acute arterial occlusion is an embolism caused by a blood clot. Other important causes include thrombosis, atherosclerosis, and peripheral arterial disease. Atrial fibrillation promotes the formation of blood clots, which can enter a blood vessel via the bloodstream and cause a sudden occlusion.

What are the symptoms of an arterial occlusion?

Typical symptoms appear suddenly and include severe pain, pallor, a sensation of coldness, and reduced blood flow to the affected limb. Depending on the location of the occlusion, additional symptoms such as sensory disturbances or limited mobility may occur. The location of the arterial occlusion often determines how severe the symptoms are.

How is an arterial occlusion treated?

Treatment depends on the cause, the location of the occlusion, and the condition of the affected limb. In addition to medication, catheter procedures, aspiration thrombectomy, Fogarty thrombectomy, or bypass surgery may be used. The goal is to quickly remove the clot and reopen the blocked artery. The best chances for successful treatment are within the first six hours and no later than 12 hours.

What are the potential consequences of an untreated arterial occlusion?

If an acute peripheral arterial occlusion remains untreated, the affected tissue may die due to the lack of blood flow. In severe cases, this can lead to tissue damage, shock, or even amputation of the affected limb. Therefore, early diagnosis and treatment are crucial to preventing vascular occlusions and preserving limb function.