Acute limb ischaemia Flashcards
1
Q
What is acute limb ischaemia?
A
- Sudden decrease in limb perfusion that threatens viability of limb
- Complete or partial occlusion of arterial supply can lead to rapid ischaemia
2
Q
Aetiology of acute limb ischaemia
A
- Embolisation - thrombus from proximal source travels distally to occlude artery eg AF, post MI, mural thrombus, AAA, prosthetic heart valves
- Thrombosis in situ - atheroma plaque in artery ruptures, thrombus forms on plaques cap - acute or acute on chronic
- Trauma - inc compartment syndrome
3
Q
6 P’s of acute limb ischaemia
A
4
Q
Risk of presenting late with acute limb ischaemia?
A
- More likely irreversible damage
- Irreversible damage to neuromuscular structures
- = paralysed limb
5
Q
What can you use to assess if limb is salvageable/threatened?
A
- Table from Rutherford et al - predicts outcome/prognosis of limb
6
Q
Bedside and bloods for acute limb ischaemia
A
- Routine - inc serum lactate to assess level of ischaemia (VBG)
- Thrombophilia screen if <50 without known risk factors
- Group and save
- ECG
- ABPI
7
Q
Imaging/tests for acute limb ischaemia
A
- Dopper USS
- Potentially CT angiogram
- If salavageable limb - CT for anatomical location and help decide operative approach
8
Q
Management initial of acute limb ischaemia - all
A
- Irreversible damage within 6 hrs - emergency
- Therapeutic dose heparin or IV heparin infusion ASAP
9
Q
Conservative vs surgical management ALI
A
- Conservative considered for those with Rutherford 1 and 2a
- = prolonged course of heparin
- Regular assessment to determine effectiveness via APTT bloods and review
- May eventually need surgery
10
Q
Surgical management ALI - when
A
- Rutherford 2b
11
Q
Surgical options for embolic cause of ALI
A
- Embolectomy - via Fogarty catheter, over a wire using radiological guidance
- Local intra-arterial thrombolysis
- Bypass surgery
12
Q
Surgical options for ALI if thrombotic disease cause
A
- Local intra-arterial thrombolysis
- Angioplasty - combined with thrombolysis
- Bypass surgery
13
Q
How is irreversible limb ischaemia treated?
A
- Urgent amputation or palliative
- Will be mottled, non-blanching appearance with hard woody muscles
14
Q
Post op care of ALI
A
- High dependency unit due to ischaemia reperfusion syndrome
15
Q
Long term management ALI
A
- Reduce CVD risk - all lifestyle factors of this
- Antiplatelet eg low dose aspirin/clopidogrel or even warfarin/DOAC
- Treat underlying RF for ischaemia eg AF
