Acute Limb Ischaemia

Question 1

What are the causes?

Answer 1

Thrombosis
Embolism
-aneurysm
- AF
- post surgery
- cholesterol
Trauma compression/dissection of artery or compartment syndrome

Question 2

What are symptoms?

Answer 2

Pain
Pulseless
Perishingly cold
Paraesthesia
Paralysed
Pale
Pain on passive movement
Mottling
Rigid muscles

Question 3

What investigations are required?

Answer 3

Bloods
- Hb
-Clotting/G&S/crossmatch
- U&Es
- ABG= lactate
- angio= if time allows
- intra-arterial digital subtraction angio= gold standard but rarely used

Question 4

What is done post op?

Answer 4

Assessment of cause
ECHO
US- look for aneurysm

Question 5

What is the management?

Answer 5

Limb threatening- revascularisation within 6 hours

Initial management
-A-E
- Cannula, NBM, fluids, analgesia
- Anticoagulation- IV heparin bolus and infusion- monitor APTT

Surgery
- Severity depends on Rutherford Criteria

Question 6

What are complications?

Answer 6

Reperfusion injury
- inflammation/oxidative damage leading to oedema, compartment syndrome, acidosis, ARDS, AKI

Compartment Syndrome

Question 7

How to determine if thrombosis cause?

Answer 7

Slower onset- hours to days
Less severe
Claudication present
Contralateral pulses often absent
Can see on angio

Question 8

How to determine if Embolism cause?

Answer 8

Sudden onset
Profound ischaemia
No claudication histroy
Present collaterol pulse
More clinical diagnosis