Acute Limb Ischaemia Flashcards
What is acute limb ischaemia?
Sudden reduction in the perfusion to a limb causing threat to limb viability
Name the causes of acute limb ischaemia
Embolic
Thrombotic
Trauma
Dissection
Illicit drug use
External compression
How is acute limb ischaemia classified?
Rutherford Classification
What is the classic presentation of acute limb ishaemia?
Pain
Pallor
Paraesthesiae
Paralysis
Perishing with cold
Pulselessness
Describe the pathological progression of limb ischaemia
Leg is white due to vasospasm and no venous filling
Vasodilatation occurs due to smooth muscle hypoxia and capillaries fill with stagnant cyanotic blood which blanches
Arteries thrombose and capillaries rupture leading to fixed blue staining of skin which does not blanch
Describe the pathological progression of limb ischaemia
Leg is white due to vasospasm and no venous filling
Vasodilatation occurs due to smooth muscle hypoxia and capillaries fill with stagnant cyanotic blood which blanches
Arteries thrombose and capillaries rupture leading to fixed blue staining of skin which does not blanch
How is acute limb ischaemia investigated?
FBC, U&E, Coagulation
ECG
Imaging - CTA
Describe the initial management of acute limb ischaemia
- oxygen
- analgesia
- IVI and fluid resus
- Foot down tilt
- Unfractionated heparin
- Revascularisation
What are the only management options for Class III acute limb ischaemia?
Primary amputation or terminal care
How is class IIb treated?
Often due to embolism, immediate surgery (embolectomy)
What are two considerations for treatment in class IIa?
Lysis and surgery
If thrombolysis is given how must it be performed?
Catheter directed through femoral access under US
Name some contraindications to thrombolysis
How are patients with acute limb ischaemia followed up?
Antiplatelet therapy/anticoagulation
Statins
