vascular Flashcards
what is acute limb ischaemia
acute deterioration in blood supply to limb over <2 weeks
what is critical limb ischaemia
end stage of peripheral arterial disease - narrowing of the vessel lumen preventing blood supply to limb
what are the 6 Ps of acute limb ischaemia
pain pallor pulselessness parasthesia perishingly cold paralysis
causes of acute limb ischaemia
embolic trauma thrombosis dissection external compression
what investigations are done for acute limb ischaemia
duplex ultrasound
ct angiogram
stage one of acute limb ischaemia
0-4 hours white foot painful sensorimotor deficit salvageable
stage 2 of acute limb ischaemia
4-12 hours
mottling
blanches on pressure
partly salvageable
stage 3 of acute limb ischaemia
>12 hours fixed mottling non-blanching compartments tender/red/painful non salvageable
management of acute limb ischaemia if diagnosed early
surgical emergency
re-establish blood flow to limb
-embolectomy +/- fasciotomy or bypass
or
-targeted thrombolysis
management of acute limb ischaemia if diagnosed late
need to remove dead limb to prevent/control sepsis and aid mobility
amputation
if patient not fit for surgery and dead limb spreading - palliation
management of compartment syndrome
urgent fasciotomy
diagnostic criteria for critical limb ischaemia
pain at rest for >2 weeks + tissue loss (ulcers)
ABPI <0.5
examination features of critical limb ischaemia
absent peripheral pulses
+buergers test
-foot blanches on elevation then reperfuses when dangled over bed
arterial ulcers/tissue loss/necrosis
hyperaemic foot
investigations for critical limb ischaemia
ABPI
ct angiogram
conservative management of critical limb ischameia
do this when just chronic not critical
- stop smoking
- graded exercise
- clopidogrel and atorvastatin
