2. Embolic Limb Ischemia Flashcards
What is embolic limb ischemia?
obstruction of vessel by lodged foreign body in bloodstream
What are sources of emboli? (Heart)
- LA in case of AF
- LV mural thrombus following MI
- Heart valve vegetations in IE
What are sources of emboli? (Arteries)
Thrombi:
-Aneurysms
-Atherosclerotic plaque
What are sources of emboli? (Other uncommon)
Air embolism
What is the pathology of embolic limb ischemia?
- Embolus arrests at anatomical narrowing
- Immediate cut off of blood supply
- VC (so collaterals not very helpful)
What are the clinical manifestations of embolic limb ischemia?
6Ps + signs & symptoms of cause
What are the clinical findings suggestive of embolic limb ischemia?
- Young age
- Sudden pain (no claudication Hx)
- Source of Emboli
- Site of major bifurcation proximal to obstruction
What are likely findings of cardiac examination in embolic limb ischemia?
- MI
- AFib
- IE
What are the investigations for embolic limb ischemia?
-no investigations
-diagnosed clinically
-treatment must not be delayed
-ischemia beyond 6hrs usually irreversible
What are the preoperative treatments for embolic limb ischemia?
- Hospitalization
- Analgesia (morphine)
- IV fluids
- Prophylactic antibiotics
- Heparinization (for propagation):
a. Unfractionated
b. LMW
What is the operative treatment for embolic limb ischemia?
Urgent Embolectomy
- Fogarty catheter (guided by Angiography)
- Local anesthesia
- Complete removal of embolus & propagated thrombus
*Fasciotomy in prolonged cases (prevents compartment syndrome)
What are the signs Embolectomy was successful?
- Felt pulsation
- Restoration of normal colour & temp
- Good back bleeding
- Completion Arteriography
What is the post-operative treatments for embolic limb ischemia?
- Heparin till pt. is amulant
- Then oral anticoagulant therapy
a. keep PT 2½ of N
b. until source of embolism is controlled - Treat cause
- Treat Complications
