Acute limb ischemia

Question 1

Presentation of acute limb ischemia?

Answer 1

Present within HOURS of:
Pain, pallor + cold, pulseless, parenthesia (indicate severity), and paralysis (late)

Question 2

What predicts impending gangrene and limb loss

Answer 2

Motor or sensory deficits

Question 2

Causes?

Answer 2

Embolus from:
-heart (A fib, post MI, valvular heart disease, prosthetic valves)

-major arteries (aortic aneurysm or popliteal aneurysm)

Question 3

Management?

Answer 3

Admission emergency
-anticoagulant with iv heparin
-give IV fluids (prevent myoglobulinurea), give mannitol and sodium bicarbonate to alkalinize urine.

-urgent embolectomy with intraop angiogram to ensure clearance
-calf fasciotomy to prevent compartment

Question 4

Rare treatment options?

Answer 4

• bypass with preop angiogram if failure of embolectomy

-thrombolytic therapy with tpa or rapilysin through intra arterial catheter into the clot. Requires up to 72 hrs to break clot NOT for life threatening cases

Question 5

Contraindications of thrombolytic therapy

Answer 5

Active internal bleeding, stroke, past hx of gastric or duodenal ulcers