Acute Limb Ischaemia Flashcards
Definition of ALI
Sudden decrease in limb perfusion that threatens the viability of the limb.
It can be either complete or partial occlusion.
This leads to rapid ischaemia and poor functional outcomes within hours.
Causes can be classified into 3 main groups.
Embolisation (AF, post-MI mural thrombus, AAA, prosthetic heart valves)
Thrombosis in situ where an atheroma plaque in the artery ruptures.
Trauma (less common) including compartment syndrome
Clinical features
Pain
Pallor
Pulselessness
Paraesthesia
Perishingly cold
Paralysis
Clinical categories of ALI
Dx
CLI
Acute DVT
Spinal cord or peripheral nerve compression
Investigations
Routine bloods including a serum lactate and a thrombophilia screen (if <50 without known risk factors)
Also a G&S + ECG
Initial investigation should also be with a bedside Doppler USS of both limbs followed by CT angiography
Initial management
Complete arterial occlusion and irreversible tissue damage can happen within 6 hours.
High flow O2 + IV access with 2 large bore cannulae.
Therapeutic dose heparin as a bolus then heparin infusion as soon as is practical.
When should conservative management be considered?
In Rutherford 1 and IIa
Explain conservative management
Prolonged course of heparin + regular assessment to determine effectiveness through APTT monitoring and clinical review.
Also assess lifestyle
Indications of surgical intervention
Ruther IIB and worse
Surgical intervention depends on what?
Whether it is embolic or thrombotic in nature
Surgical approaches of embolic
Embolectomy via Fogarty Catheter
Local intra-arterial thrombolysis (often difficult to sort within 6h)
Bypass surgery
Surgical approaches in thrombotic disease
Local intra-arterial thrombolysis
Angioplasty
Bypass surgery
What does irreversible limb ischaemia require?
Urgent amputation or palliative approach.
Long term management
Reduction of cardiovascular mortality risk
Regular exercise
Smoking cessation
Weight loss
Initiate anti-platelet agent like low-dose aspirin or clopidogrel.
Treat uncontrolled AF e.g.
In case of amputation occy health, physio and long term rehab should be discussed.
