Acute limb ischaemia

Question 1

Acute ischaemia definition

Answer 1

< 14 days

Question 2

Severity of acute limb ischaemia

Answer 2

• Incomplete: limb not threatened
• Complete: limb threatened: Loss of limb unless intervention within 6hrs
• Irreversible: requires amputation

Question 3

Causes of acute limb ischaemia

Answer 3

1) Thrombosis in situ (60%)
2) Embolus (30%) - 80% from left atrium in AF, typically lodge at femoral bifurcation
3) Others: graft occlusion, trauma, aortic dissection

Question 4

Presentation of acute limb ischaemia

Answer 4

6 Ps:

• Pale
• Pulseless
• Perishingly cold
• Painful
• Paraesthesia
• Paralysis

Question 5

Investigations of acute limb ischaemia

Answer 5

Bloods
ECG
CXR
Duplex doppler

Question 6

General treatment of acute limb ischaemia

Answer 6

Nil by Mouth
Rehydration
Analgaesia
Antibiotics
Unfractionated heparin IV infusion
Complete occlusion - urgent surgery (embolectomy/bypass)
Incomplete - angiogram and observe

Question 7

Embolus treatment

Answer 7

• Embelectomy: wire fed through embolus, fogarty catheter fed over the top, balloon inflated and catheter withdrawn.
• Thrombolysis- local tissue plasminogen activator injection
• Emergency reconstruction
• Amputation

Question 8

Thrombosis treatment

Answer 8

• Emergency reconstruction if complete occlusion
• Angioplasty
• Thrombolysis
• Amputation