TP5 - Isquemia Aguda Periférica

Question 1

Isquemia Aguda Periférica?

Answer 1

Situação clínica patológica consequente à interrupção súbita do aporte de sangue arterial a um membro

Question 2

Apresentações clínicas de Isquemia Aguda Periférica (6P)?

Answer 2

Pain
Pallor 
Pulseless 
Paraesthesia 
Paralysis
Perishing with cold

Question 3

Society for Vascular Surgery grading ischemia?

Answer 3

Class
I : Viable
II a : Marginally threatened
II b : Immediately at risk
III : Irreversible

Question 4

Etiologia?

Answer 4

Thrombosis 
- Atherosclerosis
- Bypass graft occlusion
- Popliteal aneurysm
- Prothrombotic conditions
Embolism
- Atrial fibrillation
- Cardiac vegetations: rheumatic fever, i.v. drug users 
- Mural thrombus: myocardial infarction
- Atheromatous plaque: digital emboli, blue toe syndrome

Question 5

Rarities in API?

Answer 5

Aortic dissection
Trauma
Intra-arterial drug injection 
Venous gangrene 
Popliteal entrapment 
Cervical rib

Question 6

Isquemia Aguda de Caráter Embólico? Caráter Trombótico?

Answer 6

Um embolo subitamente oclui uma árvore arterial saudável.
Aterosclerose causa estenose segmentar da árvore arterial que condiciona uma diminuição de velocidade de fluxo e superfície irregular que pode complicar com ulceração ou disseção e consequente coágulo.

Question 7

Factors predispose to in situ thrombosis?

Answer 7

 dehydration
 malignancy
 hyperviscosity
 prothrombotic syndromes

Question 8

Initial Triage (degree of ischemia)?

Answer 8

 Mild/Moderate
 Severe
 Irreversible

Question 9

Management?

Answer 9

 Surgery

 Thrombolysis

Question 10

Surgery?

Answer 10

1 - Balloon embolectomy

2 - Bypass

Question 11

Contra indicações de Thrombolysis?

Answer 11

Risco de hemorragia aumentado.
Cirurgias recentes, AVC, AIT, Craniotomias, Hx e predisposição hemorrágica, Gravidez, Malformações e aneurismas cerebrais.

Question 12

Reperfusion syndrome?

Answer 12

Systemic Inflammatory Response

Remote Organ Dysfunction

Question 13

Compartment Syndrome?

Answer 13

• pressão absoluta
• ΔP do Compartimento
  Fasciotomy

Question 14

Overview de Isquemia Aguda Periférica?

Answer 14

 High morbidity and mortality.
 Intravenous heparin (and other resuscitative measures such as intravenous fluids and oxygen).
 Surgery and thrombolysis.
 Thrombolysis > further intervention
 A combined surgical and radiological multidisciplinary approach to patient care will give the best results.