Embolism, arterial - Altmeyers Encyclopedia - Department Vascular medicine

Definition
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Carry-over of endogenous or foreign substances with displacement of a blood vessel. A distinction is made between embolism of a limb, skin, lung and brain embolism. Dermatologically relevant are in particular embolisms of the extremities (cardiac cause, displaced arteriosclerotic plaques) and skin embolisms (bacterial, fat, cholesterol and tumour-related embolisms).

Etiopathogenesis
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Embolism of the extremity arteries: Mostly mitral defect, endocarditis, heart attack. In pulmonary embolism deep pelvic vein thrombosis.

Clinical features
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Flash-like pain, lack of pulse, cold, pale skin, marbling and gangrene. In case of skin embolism picture of the livedo racemosa.

Therapy
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Arterial limb embolism: hospital admission, intensive care (shock treatment)! Full heparinization, weight-adapted with low-molecular-weight heparin, e.g. Nadroparin (Fraxiparin) 2 times/day 0.1 ml/10 kg KG s.c.; only in exceptional cases with unfractionated heparin 5,000 IU i.v. in bolus. Deep storage and cotton wool padding of the affected extremity. Conservative fibrinolysis therapy or surgical repair, especially in the case of complete occlusion by means of direct thrombarterectomy or indirect distant embolectomy.
skin embolisms:
- Bacterial embolism: treatment of sepsis. Immediate antibiosis, blood cultures!
- Fat embolism: treatment of the underlying trauma. Skin symptoms disappear within hours. Heparinization, dextran and possibly glucocorticoids may be useful.
- Cholesterol embolism: no treatment necessary. Distinction from vascular inflammatory diseases.
- Myxomembolic embolism: treatment of the underlying disease. Differentiation from vascular inflammatory diseases.
- Embolia cutis medicamentosa: S. there.