The role of transthoracic echocardiography in embolic acute limb ischaemia

  • A. Lewis
  • G. Kirk
  • A. McKinley
  • P. H. Blair
  • D. W. Harkin
Original Article



Embolic acute limb ischaemia (ALI) is commonly treated by re-vascularization and long-term anticoagulant therapy. Transthoracic echocardiography (TTE) is commonly used to screen for cardiac embolic source, but may not affect management.


We reviewed 115 consecutive patients with embolic ALI, 61% underwent TTE, with cardiac thrombus identified in only 3%. Incidental severe abnormalities requiring further cardiological investigation were detected in 19% of patients. Inpatient TTE did not affect mortality, morbidity, amputation rate, or anticoagulation.


Transthoracic echocardiography seldom identifies a cardiac embolic source, but identifies many patients with severe incidental cardiac abnormalities, suggesting cardiology screening of these patients remains important.


Acute limb ischaemia Embolism Embolectomy Transthoracic echocardiogram 


  1. 1.
    Aune S, Trippestad A (1998) Operative mortality and long-term survival of patients operated on for acute lower limb ischaemia. Eur J Vasc Endovasc Surg 15(2):143–146. doi:10.1016/S1078-5884(98)80135-4 CrossRefPubMedGoogle Scholar
  2. 2.
    Campbell WB, Ridler BM, Szymanska TH (1999) Vascular surgical society of Great Britain and Ireland: two-year follow-up after acute thromboembolic lower limb ischaemia: the importance of continuing warfarin treatment. Br J Surg 86(5):707. doi:10.1046/j.1365-2168.1999.0707a.x CrossRefPubMedGoogle Scholar
  3. 3.
    Clason AE, Stonebridge PA, Duncan AJ, Nolan B, Jenkins AM, Ruckley CV (1989) Acute ischaemia of the lower limb: the effect of centralizing vascular surgical services on morbidity and mortality. Br J Surg 76(6):592–593. doi:10.1002/bjs.1800760621 CrossRefPubMedGoogle Scholar
  4. 4.
    Clason AE, Stonebridge PA, Duncan AJ, Nolan B, Jenkins AM, Ruckley CV (1989) Morbidity and mortality in acute lower limb ischaemia: a 5-year review. Eur J Vasc Surg 3(4):339–343. doi:10.1016/S0950-821X(89)80071-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Kuukasjarvi P, Salenius JP (1994) Perioperative outcome of acute lower limb ischaemia on the basis of the national vascular registry. The Finnvasc Study Group. Eur J Vasc Surg 8(5):578–583. doi:10.1016/S0950-821X(05)80594-8
  6. 6.
    Callum K, Bradbury A (2000) ABC of arterial and venous disease: acute limb ischaemia. Br Med J 320(7237):764–767. doi:10.1136/bmj.320.7237.764 CrossRefGoogle Scholar
  7. 7.
    Asinger RW, Herzog CA, Dick CD (1993) Echocardiography in the evaluation of cardiac sources of emboli: the role of transthoracic echocardiography. Echocardiography 10(4):373–396. doi:10.1111/j.1540-8175.1993.tb00050.x CrossRefPubMedGoogle Scholar
  8. 8.
    Pearson AC (1993) Transthoracic echocardiography versus transesophageal echocardiography in detecting cardiac sources of embolism. Echocardiography 10(4):397–403. doi:10.1111/j.1540-8175.1993.tb00051.x CrossRefPubMedGoogle Scholar
  9. 9.
    Gossage JA, Ali T, Chambers J, Burnand KG (2006) Peripheral arterial embolism: prevalence, outcome, and the role of echocardiography in management. Vasc Endovascular Surg 40(4):280–286. doi:10.1177/1538574406291820 CrossRefPubMedGoogle Scholar
  10. 10.
    Forbes TL, DeRose G, Harris KA (2002) Is long-term anticoagulation after acute thromboembolic limb ischaemia always necessary? Can J Surg 45(5):337–340PubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2009

Authors and Affiliations

  • A. Lewis
    • 1
  • G. Kirk
    • 1
  • A. McKinley
    • 1
  • P. H. Blair
    • 1
  • D. W. Harkin
    • 1
  1. 1.Regional Vascular Surgery UnitRoyal Victoria Hospital BelfastBelfastUK

Personalised recommendations