Arterial embolism and thrombosis.

An effort should be made to differentiate between acute arterial embolism and acute arterial thrombosis. Most patients seen early with acute arterial embolism and a viable extremity should be heparinized and operated upon as soon as possible. Patients with acute arterial thrombosis should be treated with heparin and possibly streptokinase and not operated upon urgently. That group of patients in whom the diagnosis is in doubt and who have a viable extremity should be heparinized and have arterial exploration only if their general condition is satisfactory for an operation. Patients with a nonviable extremity should have an amputation as soon as their general condition permits. One important implication in the modern era of the management of peripheral arterial embolectomy is the requirement that the surgeon dealing with the embolus identify its source and institute appropriate treatment, whether it be replacement of a cardiac valve or removal of a proximal arterial aneurysm.