acute limb ischaemia

Question 1

what is acute limb ischaemia?

Answer 1

sudden decrease in limb perfusion

leads to rapid ischaemia

Question 2

causes

Answer 2

1. embolisation - thrombus travels distally
(AF/MI)
2. thrombosis in situ
(chronic limb ischaemia)
3. trauma

Question 3

clinical features

Answer 3

1. Pain
2. Pallor
3. Pulselessness
4. Parasthesia
5. Perishingly cold
6. paralysis

( sudden onset on these symptoms)

Question 4

Ix - first line

Answer 4

1. Doppler US

2. CT angiography

Question 5

Initial mx

Answer 5

1. surgical emergency

2. heparin infusion

Question 6

conservative mx

Answer 6

1. if limb is only minimally affected ( no motor loss/pulses are felt)
2. Mx - prolonged course of heparin / thrombolysis with streptokinase

Question 7

Surgical Mx

Answer 7

1. embolectomy

2. intra arterial thrombolysis

Question 8

main complication

Answer 8

1. reperfusion injury - sudden increase in blood supply
   - release of K+ and H+ from damaged cells causing
   hyperkalaemia / acidosis
2. myogllogin - sig AKI
3. Compartment syndrome