Lower-extremity arterial emboli from ulcerating atherosclerotic plaques.

Ten cases of lower-extremity emboli originated from proximal, ulcerated atherosclerotic plaques. Two distinct clinical presentations were seen. Embolization of cholesterol-rich debris was usually widespread and lodged in terminal arteries, producing either focal digital ischemia or livedo reticularis of the extremity. By contrast, thrombi arising from mural erosions were larger and produced a picture indistinguishable from emboli of cardiac origin. Biplanar aortography was essential in making the correct diagnosis. Anticoagulation has not prevented recurrent embolization. Endarterectomy or graft replacement of the diseased arterial segment is the preferred method of treatment. Lumbar sympathectomy is a useful adjunct when persistent cutaneous ischemia is present.