Acute Limb Ishcaemia (1*)

Question 1

What is it?

What are its 2 main causes?
→ How are they differentiated between?

Answer 1

➊ Severe, symptomatic hypoperfusion of a limb occurring for <2 weeks

➋ Thrombosis and Embolism
→ • Thrombosis presents less acutely with less severe symptoms, and often in those with a hx of claudication
• Embolism presents much more acutely (over mins) with very severe symptoms, and often in those with a hx of embolic sources (e.g. AF, recent MI)

Question 2

How does it present?

Answer 2

6 P’s:
• Pulseless
• Pain
• Pale
• Perishingly cold
• Paraesthesia
• Paralysis

N.B. In real life, loss of motor and sensory function are signs of an unsalvageable limb!

Question 3

What are the investigations to do?

How is a thrombotic cause managed?

How is an embolic cause managed?

Answer 3

➊ • Bloods - FBC, U&E, G&S, Clotting
• ECG - AF suggests an embolic cause

➋ • If incomplete, the limb is likely to remain viable for 12-24 hrs, so pts should have angiography before endovascular procedure is done (e.g. angioplasty, thrombectomy)
• If complete, pt is for urgent bypass surgery as imaging will delay management

➌ Leg is typically threatened, so pt is for immediate embolectomy

N.B. IV Heparin should be given and the pt should be kept NBM whilst waiting for surgery