“Sudden occlusion of an artery is commonly due to emboli. The source of emboli is from the hea1t or from atheroma. Increased incidence of road traffic accidents, fall or war injuries are other causes. Trauma to the artery also produces occlusion”.

EMBOLIC OCCLUSION - This occurs commonly in the peripheral arteries such as the common iliac, femoral and popliteal. An embolus is a foreign body to the bloodstream, gets lodged in a vessel and produces obstruction. lt manifests clinically as severe ischemia or gangrene, resulting in critical limb ischemia (CLI).

CRITICAL LIMB ISCHAEMIA - It is defined as persistently recurring ischemic rest pain requiring regular, adequate analgesia for more than 2 weeks or ulceration or gangrene of foot or toes with an ankle pressure of< 50 mmHg or a toe systolic pressure of< 30 mmHg

Atherosclerotic vascular disease, thromboangitis obliterans, acute embolic ischemia and even diabetes, etc. at some stage can present as CLI.

CLINICAL FEATURES

Sudden dramatic symptoms which are described in the

 form of 5 Ps - Pain – Pallor – Paresis – Pulselessness- Paraesthesia

1. Pain is severe, unbearable, burning or bursting type.
2. Limb is pale, cold and superficial veins are collapsed.
3. Paresis: Depending on the level of occlusion, the function of the limb is lost. Movement of the toes becomes difficult, followed by total paralysis.
4. Pulselessness : Characteristically, peripheral pulses below the level of embolism are not palpable.

EMBOLISM THROMBOSIS - (CAUSES)

• Atrial fibrillation • Polycythaemia rubra vera • Mitral stenosis • Thrombocythaemia • Myocardial infarction • Leukaemia • Aneurysm • High oestrogen pill • Atheromatous plaques • Atheromatous • Emboli from myxoma of heart.

INVESTIGATIONS-

• Peripheral circulation should be assessed by Doppler ultrasound, which is an excellent noninvasive investigation to judge the severity, level, position and length of superficial femoral artery stenosis. • Digital subtraction angiography in aortoiliac lesions

HOMOEOPATHIC MANAGEMENT :

AURUM METALLICUM -Aurum met is one of the best remedies for arteriosclerosis with valvular lesions. There is a sensation as if heart stopped beating for two or three seconds, immediately followed by tumultuous rebound with sinking at epigastrium.

BARYTA CARBONICUM -Baryta carb is another effective remedy for arteriosclerosis with hypertension and aneurysms. Pulse full and hard. Palpitation when lying on left side or when thinking of it.There is senile dementia , leading to confusion and mental weakness.

BARYTA MURIATICUM -Baryta mur is excellent for arteriosclerosis of aorta and large blood vessels.The heart beat is irregular and the pulse scarcely perceptible. The bllod pressure is increased and throbbing of the heart increased. Elderly person have asthma, headaches, vertigo, and tinnitus.

CACTUS GRANDIFLOROUS - Cactus grandiflorous is effective for arteriosclerosis with marked heart weakness. The heart feels clutched and released alternately by an iron band. Palpitation worse lying on left side, with vertigo, dyspnoea and flatulence.

CONIUM MACULATUM - Conium mac is best for arteriosclerosis with violent palpitations. Palpitations worse exertion, drinking, at stools. Pulse unequal and irregular. There is weakness of mind and body with vertigo, trembling and palpitations.

CONVALLARIA MAJALIS -Convallaria majalis is excellent for arteriosclerosis of cigarette smokers. Sensation as if the heart ceased beating, and then starting very suddenly. Another feature is extremely rapid and irregular pulse. Feeling as if heart beat throughout the chest.

CRATAEGUS OXYCANTHA -Crataegus is considered a heart tonic. Crataegus has got great solvent powers upon calcerous and crustaceous deposits in the lumen and arteries. There is least dysponea on least exertion. Extreme shortage of breath with heart pain. The pulse is irregular, feeble and intermittent.

NATRUM IDATUM - Natrum iodatum is for arteriosclerosis with angina pectoris , vertigo and dyspnea.

PLUMBM METALLICUM - Plumbum met is best for arteriosclerosis of anemic , weak persons and those suffering from hypertension. There is painful constriction of peripheral arteries. The pulse soft, small , dicrotic, wiry, slow, sinks even to 40. Plumbum is more indicated when chronic nephritis occurs.  

SECALE CORNUTUM - Secale cor is more indicated in the early hardening of arteries , which is rapidly progressive. Secale cor is indicated for arteriosclerosis with ice-cold extremities. There is boring pain in the chest. Dyspnea and oppression occurs with cramps in the diaphragm. Palpitation with intermittent pulse.

STRONTIUM CARBONICUM -Stronium carb is best for arteriosclerosis with high blood pressure producing a flushed face and pulsating arteries. There is violent beating of arteries and heart. Strontium is also good for arteriosclerosis with vertigo and nausea.

STROPHANTHUS HIS- Strophanthus is best for arteriosclerosis, especially tobacco smokers.The arteries are very rigid and the pulse is rapid, alternating with slow, weak, small and irregular. Cardiac pain and dyspnea.

TABACUM - Tabacum is best for hardening of coronary arteries. There is violent palpitations, worse lying on left side. Pulse thread, intermittent, hard, cord like and imperceptible.