Acute Limb Ischaemia Flashcards
What is acute limb ischaemia?
Ischaemia of a limb with a sudden onset
What is the msot common cause of acute limb ischaemia?
Ruptured atheromatous plaque in PVD
What are some other causes of acute limb ischaemia?
Thromboemoblisms formed due to:
- AAA
- Atrial fibrilation
- Post MI
What are the 6 P’s of acute limb ischaemia?
(in order of likeliness)
- Pain
- Pallor
- Pulselessness
- Paraesthesia
- Perishingly cold
- Paralysis
How can acute limb ischaemia be investigated?
- Bloods (FBC, U+E, lactate, G&S, clotting screen)
- ECG
- Doppler arteriogram
- CT arteriogram
What is the initial managment of acute limb ischaemia?
- Oxygen
- IV heprain
What are the treatment options for acute limb ischaemia?
- Conservative
- Surgical
How can acute limb ischaemia be managed conservatively?
- Use IV heparin to clear the blockage of the vessel
- This must be followed up to ensure adequate treatment
What does surgical management of acute limb ischaemia depend upon?
The cause of the ischaemia
What are the two main causes and thus surgical treatment options for acute limb ischaemia?
- Embolic
- Atheromatous
How can an embolic acute limb ischaemia be treated?
- Embolectomy
- Local thrombolysis
- Arterial bypass
How can an atheromatous acute limb ischaemia be surgically treated?
- Angioplasty
- Local thrombolysis
- Arterial bypass
How should acute limb ischaemia be managed in the long-term?
- Prescribe anti-platelet
- Manage risk factors
What are the risk factors for acute limb ischaemia?
- Diabetes
- Hyperlipidaemia
- Obesity
- Hypertension
- Pre-exisisting PVD
- Pre-existing AF/AAA/MI
What are the clinical categories for assessiing severity of acute limb ischaemia?
- Caategory 1 - Viable
- Category 2A - Marginally Threatened
- Category 2B - Immediately Threatened
- Category 3 - Irreversible
What are the signs and symptoms of Category 1 acute limb ischaemia?
- Normal sensation and motor function
- Normal arterial/venous doppler
What are the signs and symptoms of Category 2A acute limb ischaemia?
- Altered sensation in fingers/toes
- Normal motor function
- Inaudible arterial doppler
- Normal venous doppler
What are the signs and symptoms of Category 2B acute limb ischaemia?
- Altered sensation beyond the fingers/toes
- Mild motor function impairment
- Inaudible arterial and venous doppler
What are the signs and symptoms of Category 3 acute limb ischaemia?
- Profound snesory and motor function impairment
- Inaudible arterial and venous doppler
Within what time frame must acute limb ischaemia be treated regardless of category?
<6hrs
ISs tissue salvagable in Categories 2A and 2B acute limb ischaemia?
Yes, if treatment and revascularisation occurs promptly
Is tissue salvageable in Category 3 acute limb ischaemia?
Some may be but there will be permanent nerve damage and tissue loss
What are some differential diagnoses for acute limb ischaemia?
- DVT
- Chronic limb ischaemia
- Neurogenic claudication from spinal stenosis
What are the complications of acute limb ischaemia?
- Mortality rate in up to 20%
- 15% mortality rate post-operatively
- Reperfusion injury
- Compartment syndrome
- Rhabdomyolysis
