Acute Limb Ischaemia Flashcards
What is acute limb ischaemia?
Sudden loss of blood supply to a limb
How is acute limb ischaemia defined?
Severe, symptomatic hypoperfusion of a limb occurring for <2 weeks
What are the main causes of acute limb ischaemia?
Thrombosis – rupture of atherosclerotic plaques
Embolism- most commonly in a patient with atrial fibrillation
How does a thrombus cause acute limb ischaemia?
Atherosclerosis- atherosclerotic plaque ruptures and a thrombus forms
Causes occlusion of the lumen of the lower limb artery
What are the main presentinf features of acute limb ischaemia?
The 6 P’s
What are the 6 P’s?
- painful
- pulseless
- pale
- perishing with cold
- paraesthesia
- paralysed
How quickly should acute limb ischaemia be dealt with?
Within 4-6 hours.
What investigations would you carry out in someone presenting with acute limb ischaemia?
Take bloods for FBC, U&E, group and save, and clotting
ECG- atrial fibrillation ( suggests an embolic cause).
What is the management of acute limb ischaemia caused by thrombosis and incomplete ischaemia?
Patients should have angiography to map the occlusion site and plan intervention
What are the possible interventions that can be used for acute limb ischaemia caused by thrombosis of vessel?
Endovascular procedures
–Angioplasty
–Thrombectomy
–Intra-arterial thrombolysis
What is the management of acute limb ischaemia caused by thrombosis and complete ischaemia?
Urgently taken to theatre for bypass surgery
What imaging can be used to the anatomy and locate the occlusion?
USS and CT
What is the management of acute limb ischaemia caused by embolism?
In embolic causes: the leg is typically threatened and immediate embolectomy is required
What can be given to prevent thrombus propogation?
Intravenous heparin
What are the possible complications of acute limb ischaemia?
- irreversible tissue ischaemia requiring debridement
- gangrene requiring amputation
- compartment syndrome
