Acute Limb Ischemia Flashcards
Acute Limb Ischemia
SUDDEN LOSS OF LIMB PERFUSION and applicable up to 2 weeks after initiating the event -
ARTERIAL OCCLUSION –> sudden cessation of blood flow to an extremity
Acute Limb Ischemia
MC sources of arterial emboli
heart, aorta and large arteries
6 Ps of acute limb ischemia (ALI)
pain paresthesia pallor pulselessness poikilothermia paralysis
The MC source of DISTAL EMBOLI in acute limb ischemia
Heart
The MC location for an embolus to lodge
Common Femoral Bifurcation
Popliteal Trifurcation Embolus
calf ischemia
(-) pedal pulse
(+) popliteal pulse
Principal causes of ALI
embolism
thrombus in situ
arterial dissection
trauma
This should be ADMINISTERED IMMEDIATELY to prevent propagation of clot
Heparin (IV)
The ANTICOAGULANT OF CHOICE in patients with suspicion for HEPARIN-INDUCED THROMBOCYTOPENIA (falling platelets and possible thrombotic complications with recent heparin use)
Direct Thrombin Inhibitors (Argatroban, Lepriludin, And Hirudin)
Factor Xa Inhibitors (Fondaparinux)
Most effective when acute arterial occlusion is RECENT (<2 weeks) and caused by a thrombus in an atherosclerotic vessel, arterial bypass graft, or occluded stent
Intraarterial thrombolytic therapy with recombinant tissue plasminogen activator, Reteplase or Tenecteplase
Indicated when the patient’s overall condition CONTRAINDICATES SURGICAL INTERVENTION AND SMALLER DISTAL VESSELS ARE OCCLUDED
Thrombolytic Therapy
Preferred when restoration of blood flow must occur within 24 h to prevent limb loss or when symptoms of occlusion have been present for more than 2 weeks
Surgical revascularization
Indicated when acute limb ischemia is caused by CARDIAC THROMBOEMBOLISM and this prevents recurrent embolism and reduces the likelihood of thrombus propagation
Long-term Anticoagulation
Long term anticoagulation
initiated by heparin (IV) followed by warfarin (PO)
