Acute limb Ischaemia

Question 1

Definition?

Answer 1

Vascular emergency where arterial blood supply to one or more extremities is reduced

Question 2

RF?

Answer 2

• CVD risk factors
• Diabetes
• trauma

Question 3

ddx?

Answer 3

• Chronic limb ischaemia
• DVT
• Spinal cord compression

Question 4

Aetiology?

Answer 4

• Thrombosis
• Embolism
• Trauma
Venous occlusion

Question 5

CP?

Answer 5

• History of claudication
• History of heart disease
• Pain
• Pallor
• Pulselessness
• Paralysis
• Paraesthesia
Poikilothermic-cold but can be warm

Question 6

Pathophysiology?

Answer 6

• TE-Thrombus from proximal source travels distally to occlude the artery, causing ischaemia necrosis of muscle and neurovascular tissue
• Thrombosis in situ-atheroma plaque in artery rupture and thrombus forms on cap, occluding blood supply to the leg muscles
• Trauma-rupture of artery/inflammation causing occlusion or compartment syndrome causing compression of nearby structures.

Question 7

Investigations-first line?

Answer 7

• PV exam and bloods (lactate, thrombophilia), ECG
• Arterial and venous Doppler
• Absent flow distal to the site of occlusion
• CT Angiography-gold standard

Question 8

Investigations-second line?

Answer 8

• Confirm underlying causes

Question 9

Management all?

Answer 9

• High flow oxygen and IV heparin

Question 10

Management mild?

Answer 10

• Prolonged heparin and regular reviews

Question 11

Management severe?

Answer 11

• Surgery
• Embolic-
	○ Embolectomy
	○ Thrombolysis
	○ Bypass surgery
• Thrombotic disease-
	○ Angioplasty
	○  thrombolysis 
	○ bypass surgery

Question 12

Management irreversible?

Answer 12

Urgent amputation or palliative care

Question 13

Management long term?

Answer 13

• Lifestyle modification
• Anti-platelet agents
• Therapy if amputated

Question 14

Prognosis?

Answer 14

Mortality rate of 20%

Question 15

Complications?

Answer 15

• Reperfusion injury
• Compartment syndrome
• Hyperkalaemia
• Acidosis
• AKI