Acute limb ischemia

Question 1

What is acute limb ischemia

Answer 1

1. Sudden decrease in limb perfusion that threatens viability of the limb
2. Presents within 2 weeks of the symptoms

Question 2

Risk factors of ALI

Answer 2

Embolus
Thrombosis
Trauma
Dissection

Question 3

How to differentiate between emoblic and thrombotic sources

Answer 3

Source
Claudication
Findings
Angiography

Question 4

What tissues are most sensitive to ischemia

Answer 4

Nerves
Muscle
Skin
Bone
In that order

Question 5

How long can an ishemic limb survive

Answer 5

6-8 hours

Question 6

What is the presentation of acute limb ischemia

Answer 6

Pain
Perishing cold
Paraesthesia
Pallor
Paralysis
Pulselessness

Question 7

What are the differentials for acute limb ischemia

Answer 7

Acute DVT
Venous insufficiency
Blue toe syndrome
Purple toe syndrome (cutaneous necrosis from warfarin)

Question 8

How is acute limb ischemia classified

Answer 8

Rutherford classification

Question 9

What investigations to carry out

Answer 9

Biochemical and imaging
Biochem:
FBC
RP
PT/INR/APTT
GXM
Trop (For AMI)

Imaging
Doppler U/S
ECG
CT angiogram

Question 10

Managment

Answer 10

1. Early anticoagulation
2. Improve existing perfusion
3. Surgical emergency for thrombectomy/embolectomy
4. KIV fasciotomy for compartment syndrome

Question 11

How is an emergent embolectomy performed

Answer 11

-

Question 12

How is intra arterial catheter directed thrombolysis performed

Answer 12

-

Question 13

What are the contraindications for a thrombolysis

Answer 13

-

Question 14

What are the complications of surgical intervention

Answer 14

1. Reperfusion injury
2. Rhambdomylysis
3. Compartment syndrome (treat with fasciotomy)