Acute Limb Ischaemia Flashcards
What is acute limb ischemia?
Severe manifestation of PAD when the blood flow falls below a level sufficient for metabolic demands of peripheral tissues.
What are the two main causes of acute limb ischemia?
- Arterial Thrombus
- Arterial Embolism
What are the 6 P’s of acute limb ischemia symptoms?
- PAIN
- PALLOR
- PULSELESSNESS
- PARALYSIS
- PARAESTHESIA
- PERISHING WITH COLD
What type of pain is associated with acute limb ischemia?
Deep-seated, burning sensation
What does ‘pallor’ indicate in the context of acute limb ischemia?
Pale, dusky, mottled skin
What is the significance of ‘pulselessness’ in acute limb ischemia?
Absence or reduction of pulse
What are the classifications in Rutherford’s clinical categories?
- Viable (I)
- Threatened (II) - Marginally (IIA), Immediately (IIB)
- Irreversibly damaged (III)
What is often the method of diagnosis for acute limb ischemia?
Arterial Doppler examination followed by ABPI
What diagnostic imaging techniques are used for acute limb ischemia?
- ABPI
- Doppler USS
- MRA
- CTA
- Catheter-based angiography
What is the initial management for acute limb ischemia?
IV Unfractionated Heparin + Analgesia
(followed by revascularisation)
What are the surgical options for re-vascularization in acute limb ischemia management?
- Bypass grafting
- Thromboembolectomy
What are the endovascular options for re-vascularization?
- Catheter-directed thrombolysis
- Percutaneous transluminal angioplasty (PTA) with or without stenting
What long-term management strategies are important for acute limb ischemia?
- Risk factor modification e.e. stop smoking, BP/DM control, statin
- Antiplatelet therapy - lifelong aspirin or clopidogrel
What are some complications of acute limb ischemia?
- Gangrene
- Infection (Clostridium perfringens and Staphylococcus aureus)
- Rhabdomyolysis
- Limb Loss (amputation may be required if revascularization fails)
What are differential diagnoses for acute limb ischemia?
- Compartment syndrome
- Cellulitis
- DVT
What blood test are used in acute limb ischaemia?
Investigations
Bedside: ECG
Bloods: FBC, clotting, U&Es, CK (creatinine kinase - muscle breakdown - rhabdomyolysis), Group and Save, ABG (lactate)
Imaging: Doppler USS
What imaging technique is used in acute limb ischemia?
Doppler USS
