Acute Limb Ischaemia

Question 1

What is acute limb ischaemia?

Answer 1

Ischaemia of a limb with a sudden onset

Question 2

What is the msot common cause of acute limb ischaemia?

Answer 2

Ruptured atheromatous plaque in PVD

Question 3

What are some other causes of acute limb ischaemia?

Answer 3

Thromboemoblisms formed due to:

• AAA
• Atrial fibrilation
• Post MI

Question 4

What are the 6 P’s of acute limb ischaemia?

(in order of likeliness)

Answer 4

• Pain
• Pallor
• Pulselessness
• Paraesthesia
• Perishingly cold
• Paralysis

Question 5

How can acute limb ischaemia be investigated?

Answer 5

• Bloods (FBC, U+E, lactate, G&S, clotting screen)
• ECG
• Doppler arteriogram
• CT arteriogram

Question 6

What is the initial managment of acute limb ischaemia?

Answer 6

• Oxygen
• IV heprain

Question 7

What are the treatment options for acute limb ischaemia?

Answer 7

• Conservative
• Surgical

Question 8

How can acute limb ischaemia be managed conservatively?

Answer 8

• Use IV heparin to clear the blockage of the vessel
• This must be followed up to ensure adequate treatment

Question 9

What does surgical management of acute limb ischaemia depend upon?

Answer 9

The cause of the ischaemia

Question 10

What are the two main causes and thus surgical treatment options for acute limb ischaemia?

Answer 10

• Embolic
• Atheromatous

Question 11

How can an embolic acute limb ischaemia be treated?

Answer 11

• Embolectomy
• Local thrombolysis
• Arterial bypass

Question 12

How can an atheromatous acute limb ischaemia be surgically treated?

Answer 12

• Angioplasty
• Local thrombolysis
• Arterial bypass

Question 13

How should acute limb ischaemia be managed in the long-term?

Answer 13

• Prescribe anti-platelet
• Manage risk factors

Question 14

What are the risk factors for acute limb ischaemia?

Answer 14

• Diabetes
• Hyperlipidaemia
• Obesity
• Hypertension
• Pre-exisisting PVD
• Pre-existing AF/AAA/MI

Question 15

What are the clinical categories for assessiing severity of acute limb ischaemia?

Answer 15

• Caategory 1 - Viable
• Category 2A - Marginally Threatened
• Category 2B - Immediately Threatened
• Category 3 - Irreversible

Question 16

What are the signs and symptoms of Category 1 acute limb ischaemia?

Answer 16

• Normal sensation and motor function
• Normal arterial/venous doppler

Question 17

What are the signs and symptoms of Category 2A acute limb ischaemia?

Answer 17

• Altered sensation in fingers/toes
• Normal motor function
• Inaudible arterial doppler
• Normal venous doppler

Question 18

What are the signs and symptoms of Category 2B acute limb ischaemia?

Answer 18

• Altered sensation beyond the fingers/toes
• Mild motor function impairment
• Inaudible arterial and venous doppler

Question 19

What are the signs and symptoms of Category 3 acute limb ischaemia?

Answer 19

• Profound snesory and motor function impairment
• Inaudible arterial and venous doppler

Question 20

Within what time frame must acute limb ischaemia be treated regardless of category?

Answer 20

<6hrs

Question 21

ISs tissue salvagable in Categories 2A and 2B acute limb ischaemia?

Answer 21

Yes, if treatment and revascularisation occurs promptly

Question 22

Is tissue salvageable in Category 3 acute limb ischaemia?

Answer 22

Some may be but there will be permanent nerve damage and tissue loss

Question 23

What are some differential diagnoses for acute limb ischaemia?

Answer 23

• DVT
• Chronic limb ischaemia
• Neurogenic claudication from spinal stenosis

Question 24

What are the complications of acute limb ischaemia?

Answer 24

• Mortality rate in up to 20%
• 15% mortality rate post-operatively
• Reperfusion injury
• Compartment syndrome
• Rhabdomyolysis