Acute Arterial Occlusive Disease

Question 1

Embolic causes of acute arterial occlusive disease

Answer 1

Embolic

• cardiac arythmia
• mural thrombosis from MI
• rheumatic fever
• endocarditis
• aneurysm thrombus
• thrombus in atheromatous plaque
• graft thrombus

Question 2

Thrombotic causes of acute arterial occlusive disease

Answer 2

Thrombus formation on atherosclerosis
Popliteal aneurysm 
Blood disorders
COCP
Graft thrombosis

Question 3

Common sites for acute occlusion

Answer 3

Aortic bifurcation
Common femoral bifurcation
Popliteal bifurcation

Question 4

Symptoms and signs of acute occlusive disease

Answer 4

Pain
Pallor
Parasthesia
Perishingly cold
Pulseless
Mottling
Decreased sensation-> movement

Question 5

Embolus symptoms

Answer 5

Sudden severe ischemia 
Potential embolic source
Previously normal pulses
No history of arterial disease
Normal pulses in other limb

Question 6

Thrombus symptoms

Answer 6

Insidious ischemia 
No embolus source
Long standing pulse deficient
History of arterial disease
Decreased pulses in other limb

Question 7

Management-non viable limb

Answer 7

-> fixed staining of tissue
-> lack of blanching
-> anaesthesia and ridgid muscles
Amputation v. Palliatation

Question 8

Management- threatened limb

Answer 8

-> loss of sensation
-> loss of active movement
-> pain on passive movement
6h to re establish blood flow
1) cardioresp assessment
2) O2 and BP management
3) analgesia
4) clotting, cross match, ECG
5) iv fluids
6) iv heparin
7) embolectomy/thrombolysis/arterial reconstruction

Question 9

Management- non threatened limb

Answer 9

-> has sensation/movment
-> no calf tenderness
Medical optimisation and heparin
-> may improve as collaterals develop
Angiography and reconstruction electively
Reasses regularly

Question 10

Indications for amputation

Answer 10

Re vascularisation is impossible
Substantial necrotic tissue
Functionally useless foot
Deep spreading infection

Question 11

Level of amputation factors

Answer 11

Must be made through healthy tissue
-> mid tibial or above commonly
Must leave a functional stump for prosthesis
-> mid tibial, 10-12cm bellow tibial tuberosity
-> lower femoral 22-25cm bellow greater trochanter
-> Sykes maleoli inferior surface of tibia
-> mid tarsal

Question 12

Amputation rehabilitation

Answer 12

Compression for stump
Rehab hospital
Stump desensitisation
Muscle strengthening
Stump care