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#Phase 2.1: Peri Op > Acute Limb Ischaemia > Flashcards

Acute Limb Ischaemia Flashcards

1
Q

What is Acute Limb Ischaemia? (ALI) (2 things)

A
  1. Vasc emergency

2. Caused by rapid decrease in limb perfusion

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2
Q

What percentage of ALI is lower limb?

A

80%

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3
Q

What are the causes of ALI? (3 things)

A
  1. Embolisation (most common)
  2. Thrombosis in situ
  3. Trauma (less common)
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4
Q

What is embolisation?

A

Thrombus travels distally to occlude artery

a cause of ALI

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5
Q

Where do ALI causing emboli commonly arise from? (2 things)

A
  1. Heart (AF / mural thrombus)

2. AAA

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6
Q

How does thrombosis occur? (2 steps)

A
  1. Atheroma plaque in artery ruptures

2. Thrombus forms on plaque’s cap

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7
Q

What is an example of trauma that causes ALI?

A

Compartment syndrome

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8
Q

What are the risk factors for ALI? (7 things)

A
  1. Smoking
  2. DM
  3. Obesity
  4. Arterial HTN
  5. High cholesterol
  6. Sedentary lifestyle
  7. FHx vasc disease
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9
Q

What are the clinical features of ALI? (6 things)

A

Sudden onset of 6 P’s:

  1. Pain
  2. Pallor
  3. Pulselessness
  4. Paresthesia (pins and needles)
  5. Perishingly cold (to touch)
  6. Paralysis
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10
Q

What should you ask about in the history to enquire about a potential embolisation? (5 things)

A
  1. Chronic limb ischaemia
  2. AF
  3. Recent MI (–> mural thrombosis)
  4. Symptomatic AAA (back / abd pain)
  5. Peripheral aneursym
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11
Q

What is the name of the category system for ALI?

A

Rutherford categories

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12
Q

What are the Rutherford categories for ALI? (3 things)

A
  1. Viable
  2. Threatened (early / late)
  3. Irreversible
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13
Q

For a VIABLE limb in the Rutherford category of ALI:

Pain at rest?
Sensory loss?
Motor loss?
Arterial doppler audible?
Venous doppler audible?
Prognosis?
A

VIABLE

Pain at rest: NO
Sensory loss: NO
Motor loss: NO
Arterial doppler audible: AUDIBLE
Venous doppler audible: AUDIBLE
Prognosis: NO THREAT
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14
Q

For a THREATENED limb in the Rutherford category of ALI:

Pain at rest?
Sensory loss?
Motor loss?
Arterial doppler audible?
Venous doppler audible?
Prognosis?
A

THREATENED

Pain at rest: YES
Sensory loss: MINIMAL
Motor loss: MILD
Arterial doppler audible: INAUDIBLE
Venous doppler audible: AUDIBLE
Prognosis: SALVAGEABLE IF REVASC IMMEDIATELY
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15
Q

For a IRREVERSIBLE limb in the Rutherford category of ALI:

Pain at rest?
Sensory loss?
Motor loss?
Arterial doppler audible?
Venous doppler audible?
Prognosis?
A

IRREVERSIBLE

Pain at rest: YES
Sensory loss: A LOT
Motor loss: PARALYSIS
Arterial doppler audible: INAUDIBLE
Venous doppler audible: INAUDIBLE
Prognosis: MAJOR TISSUE LOSS + PERM NERVE DAMAGE
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16
Q

What lab tests should be done for a patient with suspected ALI? (5 things)

A
  1. Routine bloods
  2. Serum lactate (to assess level of ischaemia)
  3. Thrombophilia screen
  4. G&S
  5. ECG
17
Q

What imagine should be done for a patient with suspected ALI? (2 things)

A
  1. Doppler US

2. Confirmatory imaging: Digital subtraction angiography / CT angiography

18
Q

What does a Doppler US in a patient with ALI show?

A

Absence of blood flow distal to occlusion site

19
Q

How should a patient with ALI be managed initially? (3 things)

A
  1. High flow Oxygen
  2. IV access
  3. Therap dose Heparin / bolus done then infusion
20
Q

How should a patient with a VIABLE / EARLY THREATENED Rutherford category ALI be managed?

A

Conservatively:

Prolonged heparin course (w regular APPT assessment)

21
Q

How should a patient with a LATE THREATENED Rutherford category ALI be managed?

A

Surgically

22
Q

What is the surgical management for a patient with LATE THREATENED Rutherford category ALI caused by EMBOLIC causes? (3 things)

A
  1. Embolectomy
  2. Local intra-arterial thrombolysis
  3. Bypass surgery (if insuff flow back)
23
Q

What is the surgical management for a patient with LATE THREATENED Rutherford category ALI caused by THROMBOTIC DISEASE? (3 things)

A
  1. Local intra-arterial thrombolysis
  2. Angioplasty
  3. Bypass surgery
24
Q

How should a patient with a IRREVERSIBLE Rutherford category ALI be managed?

A

Urgent amputation / palliative

25
Q

How should an ALI patient be managed in the long term? (4 things)

A
  1. Reduce CVS mortality risk (smoking cessation / exercise / weight loss)
  2. Antiplat agent (low dose aspirin / clopidogrel)
  3. Anticoag (warfarin / DOAC)
  4. Treat underlying condition (AF)
26
Q

What are the complications of ALI? (2 things)

A
  1. Mortality (20%)

2. Reperfusion injury (sudden increase in cap perm)

27
Q

What does reperfusion injury cause? (2 things)

A
  1. Compartment syndrome
  2. Damage muscle cells releasing:
    - K+ –> hyperkalaemia
    - H+ –> acidosis
    - Myoglobin –> AKI

#Phase 2.1: Peri Op (24 decks)

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