Acute on chronic limb ischemia

Question 1

Define and differentiate from acute limb ischemia

Answer 1

Patients present with pain after DAYS of onset. They have hx of CLI claudication. The limb is viable so they can move the toes, pulses are felt, and the calf is soft and mildly tender.

Due to development of collaterals

Question 2

Management?

Answer 2

Similar to critical limb ischemia

-admit and give iv heparin
-angiogram
-bypass or endovascular repair

Question 3

Blue toe vs trash toe

Answer 3

Blue toe: blue toes discoloration with palpable peripheral pulses due to microemboli from ruptured plaques

Trash toe: blue toes discoloration with palpable pulses due to emboli of debris from surgical site following surgery

Question 4

Management of blue toe

Answer 4

Iv heparin with/without prostacyclin and platelets

Duplex and angiogram to look for proximal aneurysm in aorta and treat accordingly

Question 5

Sites of amputation LL

Answer 5

Above knee
Below knee
Ankle (rare)
Transtarsal (at tarsometatarsal joint)

Transmetatarsal at metatarsal bones
Toe amputations