Acute Arterial Occlusion Flashcards
Definition of acute limb ischaemia
Sudden, total occlusion of the arterial supply in the presence of inadequate collateral circulation
<2 weeks
Aetiology of acute limb ischaemia
- emboli
- thromosis
- vascular inflammatory diseases
- trauma (external compression, dissection, compartment)
- severe venous diseases
- hypercoagulable states
Pathogenesis of a thrombus
- acute on chronic occlusion
- underlying arterial disease
- atherosclerosis
- often Hx of IC
Pathogenesis of embolism
- acute occlusion of relatively normal artery
- distant source
Sources of emboli
Cardiac
- atrial fibrillation
- mural thrombus
- valvular vegetations
Atherosclerotic plaque of proximal vessel
Symptoms of acute limb ischaemia
- sudden onset severe pain
- cold, pale limb
- parasthesia
- muscle fatigue/ paralysis
Signs of acute limb ischaemia
- absent pulses
- marble appearance
- decreased temp, sensation, motor function, cap filling
- tender muscle compartments
End stage signs of acute limb ischaemia
- demarcation
- skin discolouration
- blistering
- gangrene
6 Ps of acute arterial occlusion
- pain
- parasthesia
- pallor
- pulselessness
- paralysis
- poikilothermia
How to classify acute limb ischaemia
Rutherford classification
Categories of the Rutherford classification
1 = viable 2a = marginally threatened 2b = immediately threatened 3 = irreversible
Important for diagnosis of acute arterial insufficiency
- history (IC, IHD, risk factors)
- exam (AF, signs)
- thrombosis vs embolism
- investigate (duplex, arteriography)
Emergency treatment of acute arterial insufficiency
- heparin 100IU/kg IVI stat
- analgesia
- protect limbs (pressure points, raise head)
- maintain circulation + oxygenation
- refer to specialist vascular unit
What does PTA stand for?
Percutaneous transluminal angioplasty
Systemic complications of revascularisation
- reperfusion sydrome
- metabolic acidosis
- hyperkalaemia
- cardiac arrhthmias
- renal shut-down
