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Junior Surgery- Vascular > Acute Limb Ischaemia > Flashcards

Acute Limb Ischaemia Flashcards

1
Q

What is acute limb ischaemia?

A

The sudden decease in limb perfusion that threatens the viability of the limb. Can be caused by complete or partial occlusion and occurs within hours.

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2
Q

What can cause acute limb ischaemia?

A
  • Embolus (most common)
  • Thrombus (atheromatous plaque rupture)
  • Trauma (least common)
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3
Q

What causes emboli in acute limb ischaemia?

A
  • AF
  • Post-MI
  • Mural-thrombus
  • AAA
  • Prosthetic heart valves
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4
Q

Name an example of trauma

A

Compartment Syndrome

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5
Q

What are the clinical features of acute limb ischaemia?

A

6 Ps

  • Pain
  • Pallor
  • Pulselessness
  • Paraesthesia
  • Perishingly cold
  • Paralysis
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6
Q

Which of the 6 Ps are most common?

A
  • Pain
  • Pallor
  • Pulselessness
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7
Q

If the contralateral limb is warm and pulsatile, what is the most likely diagnosis?

A

Embolism

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8
Q

What are the categories of acute limb ischaemia?

A 
Rutherford's
1- Viable
2a- Marginally Threatened
2b- Immediately Threatened
3- Irreversible
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9
Q

Outline a stage 1 case in terms of:

  • Prognosis
  • Sensory Loss
  • Motor Deficit
  • Arterial Doppler
  • Venous Doppler
A

Viable

  • Prognosis - No immediate threat
  • Sensory Loss - None
  • Motor Deficit - None
  • Arterial Doppler - Audible
  • Venous Doppler - Audible
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10
Q

Outline a stage 2a case in terms of:

  • Prognosis
  • Sensory Loss
  • Motor Deficit
  • Arterial Doppler
  • Venous Doppler
A

Marginally Threatened

  • Prognosis - Salvageable if treated promptly
  • Sensory Loss - Toes, if any
  • Motor Deficit - None
  • Arterial Doppler - Inaudible
  • Venous Doppler - Audible
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11
Q

Outline a stage 2b case in terms of:

  • Prognosis
  • Sensory Loss
  • Motor Deficit
  • Arterial Doppler
  • Venous Doppler
A

Immediately Threatened

  • Prognosis - Salvageable if immediately revascularised
  • Sensory Loss - More than toes/Rest pain
  • Motor Deficit - Mild/Moderate
  • Arterial Doppler - Inaudible
  • Venous Doppler - Audible
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12
Q

Outline a stage 3 case in terms of:

  • Prognosis
  • Sensory Loss
  • Motor Deficit
  • Arterial Doppler
  • Venous Doppler
A

Irreversible

  • Prognosis - Major tissue loss/Inevitable
  • Sensory Loss - Profound
  • Motor Deficit - Paralysis
  • Arterial Doppler - Inaudible
  • Venous Doppler - Inaudible
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13
Q

When is irreversible damage expected to begin?

A

6 hours after symptom onset

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14
Q

How should suspected cases be imaged?

A
  • Doppler USS

- CT angiogram immediately after

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15
Q

What bloods should be done?

A
  • Full profile
  • Group and save
  • INR (hypercoaguability)
  • ABG (Lactate to assess level of ischaemia)
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16
Q

What initial management is important?

A
  • Investigations
  • Surgical referral
  • Oxygen
  • Therapeutic dose heparin
  • IV Access
  • Analgesia
17
Q

When can conservative management be used/trialled instead of surgery?

A

Rutherford’s 1 or 2a

18
Q

What is the conservative management?

A
  • Treatment dose heparin (prolonged course)

- Regular follow up with APTTs

19
Q

What surgeries are used in embolic cases?

A
  • Embolectomy via Fogarty catheter
  • Local intra-arterial thrombolysis
  • Bypass surgery (if there is insufficient flow back)
20
Q

What surgeries are used in thrombotic cases?

A
  • Local intra-arterial thrombolysis
  • Angioplasty/stenting
  • Bypass surgery
21
Q

How are irreversible cases surgically treated?

A

Amputation

22
Q

How are cases managed long-term post surgery?

A
  • Reduce cardiovascular risk
  • Anti-platelets/anti-coagulation
  • OT/Physio, especially with amputation
23
Q

What is the mortality of acute limb ischaemia?

A

20% at 5 years

24
Q

What can reperfusion result in?

A

Reperfusion injuries

  • Compartment syndrome
  • Release of substances from the damaged muscle cells
25
Q

What can be released from damaged muscle cells?

A
  • K+ ions causing hyperkalaemia
  • H+ ions causing acidosis
  • Myoglobin, resulting in AKI

Junior Surgery- Vascular (6 decks)

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