Peripheral Arterial Disease: Acute Limb-Threatening Ischaemia Flashcards
what is the 3 main patterns of presentation in peripheral arterial disease?
- intermittent claudication
- critical limb ischaemia
- acute limb-threatening ischaemia
what are the features of acute limb-threatening ischaemia?
6 Ps
* pale
* pulseless
* painful
* paralysed
* paraesthetic
* ‘perishing with cold’
1 or more
what is the initial investigation in suspected acute limb-threatening ischaemia?
handheld arterial doppler examination
what should be performed if handheld arterial doppler is present in suspected acute limb-threatening ischaemia?
ankle-brachial pressure index (ABI)
what are the causes of acute limb-threatening ischaemia?
- thrombus (due to rupture of atherosclerotic plaque)
- embolus (e.g. secondary to atrial fibrillation)
what factors suggest the cause of acute limb-threatening ischaemia is a thrombus?
- claudication with sudden deterioration
- no obvious source for emboli
- reduced or absent pulses in contralateral limb
- evidence of widespread vascular disease (e.g. MI, stroke, TIA)
thrombus think chronic
what factors suggest the cause of acute limb-threatening ischaemia is an emboli?
- sudden onset of painful leg (<24 hours)
- no history of claudication
- clinically obvious source of emboli (e.g. AF, recent MI)
- normal pulses in contralateral limb
- evidence of proximal aneurysm (e.g. abdominal or popliteal)
emboli think acute
what is the initial management of acute limb-threatening ischaemia?
ABCDE
* analgesia = IV opioids
* IV unfractionated heparin
* vascular review
why is unfractionated heparin given in acute limb-threatening ischaemia?
prevent thrombus propagation
what is the definitive management of acute limb-threatening ischaemia?
- intra-arterial thrombolysis
- surgical embolectomy
- angioplasty
- bypass surgery
- ampuation
when do you consider amputation?
irreversible ischaemia
