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February 19, 1973

Acute Peripheral Arterial Occlusion

Author Affiliations

From the Department of Surgery, Peter Bent Brigham Hospital and the Department of Anatomy, Harvard Medical School, Boston.; Max Harry Weil, MD, and Herbert Shubin, MD, Shock Research Unit, University of Southern California, Los Angeles, are co-editors of the Critical Care Medicine series.

JAMA. 1973;223(8):909-912. doi:10.1001/jama.1973.03220080039010

Sudden cessation of major arterial flow in the extremities may be caused by physical obstruction of the arterial lumen or by reduction in effective flow when vascular volume or perfusion pressure is critically decreased or when the resistance in small arteries or venules is markedly increased (Table 1).

Arterial obstruction is probably most frequently encountered in patients who have had an arterial puncture or cannulation for left atrioventricular catheterization, arteriography, or physiological monitoring. In a collective study of 12,367 patients who had cardiac catheterization, Braunwald and Swan1 noted an arterial complication rate of only 0.3%. This low incidence of complications probably represents only truly disastrous events and contrasts sharply with the experience of others. In catheter procedures, the loss of the peripheral pulse per se, irrespective of symptoms of ischemia, has been encountered in about 30% of the cases.2-5 Intra-arterial injection of hypertonic or otherwise irritating material, including concentrated