[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Hemodynamic disorders](https://durgical.com/en/general-pathology/#a-hemodynamics) › Systemic (arterial) thromboembolism

[General pathology](https://durgical.com/en/general-pathology/) · [Hemodynamic disorders](https://durgical.com/en/general-pathology/#a-hemodynamics)

# Systemic (arterial) thromboembolism

- Mechanism

Emboli that travel in the arteries nearly always start in the left heart and end up in the legs, brain, gut, kidney or spleen.

Updated 2026-11-01

## Key points

- Main source: mural thrombi in the left heart (left ventricular infarct, atrial fibrillation).
- Destinations: the lower limbs most often, then the brain; also gut, kidney, spleen and upper limbs.
- Acute limb ischemia: pain, pallor, pulselessness, paresthesia, paralysis and coldness.
- Acute mesenteric ischemia: pain out of proportion to the examination, typical of an embolus in the superior mesenteric artery.
- Atheroembolism: cholesterol crystals after catheterisation; blue toes, kidney injury, cholesterol clefts on biopsy.

## What it is

Systemic thromboembolism is the arrival of emboli in the arterial circulation. Most come from mural thrombi in the left heart: an infarcted or dilated ventricle, or a left atrium in atrial fibrillation. Other sources are valve vegetations, aortic aneurysms and plaques, and paradoxical embolism. Unlike venous emboli, they nearly always cause infarction, because they reach end arteries.

## Step by step

- A thrombus forms in the left heart or the aorta.
- A fragment breaks off and follows the arterial flow.
- It lodges where the vessel becomes narrower than the embolus, often at a branch point.
- Without enough collateral circulation, the territory becomes ischemic.
- Without reperfusion, an infarct follows within minutes to hours.

## Sources of arterial emboli

| Source | Why the thrombus forms | Common destination |
| --- | --- | --- |
| [Left ventricular infarct](https://durgical.com/en/conditions/myocardial-infarction/) | Akinetic wall and damaged endocardium | Brain, limbs |
| [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) | Stasis in the left atrial appendage | Brain (cardioembolic stroke) |
| [Chagas cardiomyopathy](https://durgical.com/en/conditions/chagas-cardiomyopathy/) | Apical aneurysm with mural thrombus | Brain |
| [Valve vegetations](https://durgical.com/en/conditions/infective-endocarditis/) | Infective or nonbacterial endocarditis | Brain, spleen, kidney; septic emboli |
| [Aortic aneurysm or plaque](https://durgical.com/en/conditions/abdominal-aortic-aneurysm/) | Mural thrombus or ulcerated atheroma | Lower limbs, kidney, gut |
| Paradoxical embolism | Venous thrombus crossing a patent foramen ovale | Brain |

## Clinical notes

- In Colombia, Chagas disease (Trypanosoma cruzi) is a cause of cardioembolic stroke in people from endemic areas, sometimes as the first sign of the cardiomyopathy.
- Rheumatic mitral stenosis with a dilated left atrium is still a source of emboli in Latin America.
- Embolic occlusion of the central retinal artery causes sudden, painless loss of vision.

## Memory aid

The left heart fires; the legs and the brain catch.

## Test yourself

Think of the answer, then tap the question to see it.

## Where do most systemic arterial emboli come from?

From mural thrombi in the left heart, above all after a myocardial infarction or in atrial fibrillation.

## What is the commonest destination of arterial emboli?

The lower limbs, followed by the brain.

## What does the pathologist see in renal atheroembolism?

Long, needle-shaped clefts where the cholesterol crystals were, inside small arteries.

## Why does Chagas disease cause stroke?

Because Chagas cardiomyopathy forms ventricular aneurysms and mural thrombi that embolise to the brain.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/systemic-thromboembolism/)

## Related

- [Arterial vs venous thrombi; mural thrombi and lines of Zahn](https://durgical.com/en/general-pathology/arterial-vs-venous-thrombi-mural-thrombi-and-lines-of-zahn/)
- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Fat, air and amniotic fluid embolism](https://durgical.com/en/general-pathology/fat-air-and-amniotic-fluid-embolism/)
- [Pulmonary thromboembolism: where it comes from and what it does](https://durgical.com/en/general-pathology/pulmonary-thromboembolism-where-it-comes-from-and-what-it-does/)

## Related conditions

- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/)
- [Acute limb ischaemia](https://durgical.com/en/conditions/acute-limb-ischaemia/)
- [Acute mesenteric ischaemia](https://durgical.com/en/conditions/acute-mesenteric-ischaemia/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Chagas cardiomyopathy](https://durgical.com/en/conditions/chagas-cardiomyopathy/)
- [Transient ischaemic attack](https://durgical.com/en/conditions/transient-ischaemic-attack/)
- [Central retinal artery occlusion](https://durgical.com/en/conditions/central-retinal-artery-occlusion/)
- [Mitral stenosis](https://durgical.com/en/conditions/mitral-stenosis/)
- [Dilated cardiomyopathy](https://durgical.com/en/conditions/dilated-cardiomyopathy/)
- [Atheroembolic renal disease (cholesterol crystal embolism)](https://durgical.com/en/conditions/atheroembolic-renal-disease/)

## Elsewhere in DurgiPedia

- [Cerebral blood flow, brain metabolism and intracranial pressure](https://durgical.com/en/physiology/cerebral-blood-flow-brain-metabolism-and-intracranial-pressure/)

## Microorganisms

- [Trypanosoma cruzi](https://durgical.com/en/microbiology/trypanosoma-cruzi/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Arterial embolism: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001102.htm) (MedlinePlus, US National Library of Medicine, 2026); [Stroke: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000726.htm) (MedlinePlus, US National Library of Medicine, 2025); [Acute Mesenteric Ischemia](https://www.ncbi.nlm.nih.gov/books/NBK431068/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/general-pathology/systemic-thromboembolism/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/systemic-thromboembolism/