Acute ischaemic limb and occlusions Flashcards
Features of acute limb-threatening ischaemia
Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishingly cold
Initial investigations for acute limb ischeamia
Handheld arterial doppler
If doppler signals present need to obtain ABI
Factors suggestive of thrombus
Pre-existing claudication with sudden deterioration
No obvious source for emboli
Reduced or absent pulses in contralateral limb
Evidence of widespread vascular disease (e.g. MI, stroke, TIA, previous vascular surgery)
Factors suggestive of embolus
Sudden onset painful leg <24h
No history of claudication
Clinically obvious source of embolus e.g. af, recent MI
No evidence of peripheral vascular disease
Evidence of proximal aneurysm e.g. abdominal or popliteal
Initial management of acute limb ischeamia
ABC approach
Analgesia- IV opioids often used
IV unfractionated heparin to prevent thrombus propagation, particularly if not suitable for immediate surgery
Vascular review
Definitive management of acute limb ischeamia
Intra-arterial thrombolysis
Surgical embolectomy
Angioplasty
Bypass surgery
Amputation- for patients with irreversible ischaemia
Critical limb ischaemia features
Rest pain in foot for more than 2 weeks
Ulceration
Gangrene
Interpretation of ABPI
1- normal
0.6-0.9- claudication
0.3-0.6- rest pain
<0.3- impending critical limb
Intermittent claudication
Crampy pain predictably after walking a certain distance
Pain disappears after stopping and resting
Leriche syndrome
Occlusion in the distal aorta or proximal common iliac artery
Leriche syndrome triad
Thigh/ buttock claudication
Absent femoral pulses
Male impotence
Management of intermittent claudication
Lifestyle changes
Exercise training
Medical treatments- atorvastatin, clopidogrel, naftidrofuryl oxalate
Surgical options- endovascular angioplasty and stenting, endarterectomy, bypass surgery
