Acute Arterial Occlusion

Recognition

Causes: Arterial embolism (most common — a clot from the heart, typically from atrial fibrillation, valvular disease, or post-MI mural thrombus, travels distally and lodges in a peripheral artery). Acute arterial thrombosis (a ruptured atherosclerotic plaque triggers in-situ clot formation in a narrowed vessel). Or arterial trauma.
The 6 P's:
Pain — sudden, severe, disproportionate to any visible injury
Pallor — the limb appears white or mottled
Pulselessness — loss of distal pulse at or below the level of occlusion
Paresthesia — numbness or tingling from ischemic sensory nerve dysfunction
Paralysis — weakness or inability to move the limb (late and ominous sign indicating severe ischemia)
Poikilothermia — the limb is cold compared to the contralateral side
Progression: The limb becomes progressively mottled, then cyanotic. Paralysis and loss of sensation indicate that ischemia has progressed to a point where limb viability is threatened.
Key differentials: Raynaud's phenomenon (episodic, bilateral, reversible color changes with rewarming) and DVT (warm swelling, not cold and pulseless) — both present differently from acute arterial occlusion.

Absolute contraindication. Active acute arterial occlusion is a life-threatening emergency. Massage of the affected limb is absolutely contraindicated — any manual stimulation can worsen ischemia or mask symptom progression.
If discovered during a session: Stop immediately, keep the client still and calm, do not elevate the limb (elevation worsens arterial ischemia — keep at or below heart level), and call 911.
Post-recovery: Clients who have undergone surgical revascularization or thrombolysis require medical clearance before massage. Work within the limits established by their vascular surgeon.
AFib clients on anticoagulants are the highest-risk population for future embolic events — the same anticoagulant awareness (pressure modification for bruising risk) applies.

Any of the 6 P's detected during assessment or treatment: Stop treatment immediately, call 911
Sudden unilateral limb pain + cold + pulseless: Vascular emergency — do not elevate the limb, call 911
Post-revascularization client requesting massage: Require medical clearance from vascular surgeon

Acute arterial occlusion is a vascular emergency — the 6 P's (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia) constitute a red flag requiring immediate emergency response
Tissue necrosis begins within 4–6 hours without restoration of blood flow — time is limb
Massage is absolutely contraindicated in acute presentation. Stop treatment and call emergency services
Do not elevate the ischemic limb — keep at or below heart level
Distinguish from Raynaud's (episodic, bilateral, reversible) and DVT (warm swelling, not cold and pulseless)
Post-event clients require vascular surgeon clearance and anticoagulation-aware pressure modification