Acute Arterial Occlusion Diagnosis and Management

Clinical Presentation and Diagnosis

The combination of unilateral absence of pulse and blood pressure with ipsilateral tingling/numbness points directly to acute arterial insufficiency rather than a primary neurological event, according to the American College of Cardiology 1
Ipsilateral symptoms (left-sided neurological symptoms with left-sided vascular compromise) indicate peripheral vascular pathology, not central nervous system disease, as stated by the American Heart Association 1
Absent pulse and unmeasurable blood pressure on the affected side confirms arterial occlusion—this is pathognomonic for large vessel obstruction, as noted by the American College of Cardiology 2

Compare bilateral blood pressures in both arms—>20 mmHg difference confirms significant arterial compromise, as recommended by the European Society of Cardiology 4
Assess the "6 P's" of acute limb ischemia: Pain, Pallor, Pulselessness (confirmed), Paresthesias (confirmed), Poikilothermia (cool limb), Paralysis, as suggested by the American Heart Association 2
Check capillary refill and skin temperature of left hand versus right, as advised by the American College of Cardiology 2

CT angiography from aortic arch to fingertips is the gold standard, according to the American College of Radiology 5
Identifies occlusion location and extent, and differentiates thrombosis from dissection, as stated by the American College of Cardiology 1

Do NOT elevate the affected limb—keep at heart level or slightly dependent to maximize perfusion, as recommended by the American Heart Association 2
Initiate anticoagulation (heparin bolus followed by infusion) unless contraindicated, to prevent thrombus propagation, as suggested by the American College of Cardiology 2
Supplemental oxygen if oxygen saturation <94%, as advised by the American Heart Association 2
Endovascular thrombectomy/thrombolysis for acute thromboembolism, as recommended by the American College of Cardiology 1
Fasciotomy if compartment syndrome develops post-reperfusion, as noted by the American College of Cardiology 2

Outcome depends entirely on time to reperfusion, as stated by the American Heart Association 2
The combination of motor and sensory symptoms indicates advanced ischemia requiring immediate intervention, as recommended by the American College of Cardiology 2