Thrombus | Atherosclerosis or thrombosis of bypass grafts | Intermittent claudication | Medical first, then consider interventional |
Embolism | Cardiac source: atrial fibrillation, rheumatic heart disease, mechanical valves, post–myocardial infarction thrombus, atrial myxomas and leaflet vegetations | Sudden onset of territorial arterial symptoms | Preventative anticoagulation, embolectomy |
Catheterization complication (brachial or femoral) | Can occur during standard angioplasty, angiography, or arterial blood gas | Expanding hematoma, pain, temperature and pulse changes | Conservative vs. operative repair |
Trash foot or blue toe syndrome | Cholesterol/platelet aggregate emboli | Painful cyanotic discoloration of isolated portion of foot; remainder of the foot is warm | Conservative therapy |
Vasculitis: rheumatoid arthritis, lupus, polyarteritis nodosa | Autoimmune inflammation of small arteries | Systemic symptoms and multiorgan ischemia | Steroids, immunosuppressive agents |
Raynaud's disease | Vasospasm in small arteries or arterioles provoked by cold or stressors | Local pain, pallor, cyanosis, numbness, paresthesias in hands usually resolving in 30–60 min | Rewarming, medications: calcium channel blockers, α-blockers, vasodilators |
Takayasu's arteritis | Autoimmune vasculitis of aortic arch and branches | Young Asian women: peripheral ischemia and necrosis leading to pulseless phase; may have fever, rash, muscle aches, arthritis | Steroids, immunosuppressive agents |
Thromboangiitis obliterans (Buerger's disease) | Nonatherosclerotic segmental inflammation of small/medium vessels; typically, only seen in smokers | Painful nodules, ulceration, and gangrenous digits in young adults (age 20–40 y) | Smoking cessation |
HIV arteritis9 | Chronic inflammation of arteries associated with low CD4 counts | Intermittent claudication | Optimization of HIV management, angioplasty, or vein graft |
Hypothenar hammer syndrome | Repeated trauma to the hypothenar area with hammering in laborers, as well as those using vibrational tools, causing narrowing of ulnar artery or aneurysmal degeneration | Painful discoloration of one or more ulnar fingers with sparing of thumb | Aspirin, nifedipine, intra-arterial fibrinolysis, interposition vein graft |
Popliteal artery entrapment (young males) and popliteal aneurysms (older males)10 | Anatomic crowding of popliteal fossa with anomalous relationships between popliteal artery and surrounding muscle and fascia or luminal narrowing and thrombosis of aneurysm | Pain in anterior aspect of lower one third of leg with exercise, reproducible with active ankle plantar flexion or passive dorsiflexion | Surgical repair of popliteal fossa or aneurysm and grafting |
External iliac artery endofibrosis11 | External iliac artery fibrosis secondary to prolonged hip flexion | Thigh pain and numbness in cyclists and triathletes: measure pre- and postcycling ankle-brachial indexes | Surgical management or catheter dilatation |
Local arterial trauma12,13 | Penetrating or blunt damage to vessel | Suspect in patients with knee dislocation or penetrating extremity trauma | Surgical repair |
Shock-related arterial ischemia | Low cardiac output states: congestive heart failure, sepsis, cardiogenic or hypovolemic shock | Generalized hypoperfusion | Resuscitation with fluids, blood products, vasopressors, inotropes; treat infection |
Thoracic aortic dissection | False lumen of dissection occludes arteries | Chest or back pain | Surgical repair |