Cardiac Causes of Acute and Chronic Limb Ischemia

Acute limb ischemia occurs from an abrupt interruption of blood flow to an extremity, usually because of embolic or thrombotic vascular occlusion. It can also result from trauma and dissection. With an embolic occlusion, a cardiac origin is the source of emboli in 80–90 % of cases, usually in the setting of atrial fibrillation/flutter or acute myocardial infarction (O’Connell and Quinones-Baldrich, Semin Vasc Surg. 22(1):10–16, 2009). The presence of rheumatic or prosthetic cardiac valves, endocarditis, and cardiac tumors (such as left atrial myxoma) is also associated with increased risk of embolic events. Furthermore, paradoxical embolism of venous thrombi through an intra-atrial communication (such as an atrial septal defect (ASD) or patent foramen ovale (PFO)), or less commonly an intraventricular communication, is also encountered in some patients. Hence, this chapter discusses cardiac causes of limb ischemia including dissection.