Acute limb ischemia

Question 1

Define acute limb ischemia

Answer 1

Sudden decrease in limb perfusion resulting in potential threat to limb viability

Question 2

Give the aetiology of acute limb ischemia

Answer 2

Thrombosis
Embolism

Arterial trauma
Arterial dissection
Arteritis
HIV vasculopathy
Hypercoagulability
Popliteal adventitial cyst
Popliteal entrapment
Compartment syndrome
Paradoxical emboli 
Ergotism

Question 3

Name the 6Ps of acute limb ischemia

Answer 3

Pain
Pulselessness
Pallor
Paresthesia
Paralysis
Poikilothermia

Question 4

How is acute limb ischemia classified?

Answer 4

Rutherford’s classification

Question 5

Discuss Rutherford’s classification of acute limb ischemia

Answer 5

Stage 1: Limb viable

• no sensory loss
• no muscle weakness
• arterial audible
• venous audible

Stage 2a: Limb marginally threatened

• minimal sensory loss (toes)
• no muscle weakness
• arterial inaudible
• venous audible

Stage 2b: Limb immediately threatened

• pain at rest (>toes)
• mild muscle weakness
• arterial inaudible
• venous audible

Stage 3: Limb irreversibly damaged

• profound pain
• profound muscle weakness
• arterial inaudible
• venous inaudible

Question 6

Name conditions that mimic acute limb ischemia

Answer 6

Systemic shock
Phlegmasia cerulean dolens
Acute compressive neuropathy

Question 7

Name investigations in acute limb ischemia

Answer 7

Bloods (FBC, clotting profile, CK)

Angiography

Question 8

Discuss the management of acute limb ischemia

Answer 8

Immediate UFH IVI

Intervention

1. Endovascular
   - catheter directed thrombolysis
   - thrombectomy
   - angioplasty and stenting
2. Open
   - embolectomy
   - surgical bypass
   - fasciotomy
3. Amputation

Question 9

Name complications of ischemic reperfusion injury

Answer 9

Compartment syndrome
Renal failure
ARDS
Hyperkalemia