Acute Limb Ischaemia Flashcards
What is acute limb ischaemia?
Sudden decrease in limb perfusion
Blockage of peripheral artery
How quickly do you need to treat acute limb ischaemia?
ischaemia > 6 hours = irreversible
Causes of acute limb ischaemic
Traumatic
- bone fracture
- penetrating wound
Non-traumatic
- embolism
- thrombolism
What is an embolism?
Blockage of a blood vessel by a solid, liquid or gas at a site distant from its origin
What is a thrombosis?
Formation of a solid mass of blood within the circulatory system
Signs of acute limb ischaemia is caused by an embolus
Very sudden onset
Identifiable source
Unilateral
Few signs of PVD
Arteriography - sudden blood supply cut off
Signs of acute limb ischaemia is caused by a thrombus
Less sudden onset
Signs of claudication
Bilateral
Signs of PVD
Arteriography - atherosclerosis
Clinical features of acute limb ischaemia
6 Ps
- pain
- pallor
- pulseless
- paraesthesia
- perishingly cold
- paralysis
Clinical classification of acute limb ischaemia (Rutherford)
Grade I - viable
- no immediate threat
- no sensory or motor loss
- audible arterial & venous doppler
Grade IIa - marginally threatened
- salvagable, if treated
- minimal sensory loss, no motor loss
- inaudible arterial doppler
Grade IIb - immediately threatened
- salvagable, if immediately revascularised
- moderate sensory & motor loss
- inaudible arterial doppler
Grade III - irreverisible
- major tissue loss
- profound sensory & motor loss
- inaudible arterial & venous doppler
Initial management of acute limb ischaemia
IV heparin
ECG - rule out AF or MI
Conservative management of acute limb ischaemia
Rutherford I or IIa
Heparin
Regular assessment
Surgical management of acute limb ischaemia
Rutherford IIb
Embolic cause
- fogarty catheter - embolectomy
Thrombolic cause
- thrombolysis
- angioplasty
Irreversible = urgent amputation
Complications of acute limb ischaemia
Compartment syndrome
Damaged muscle cells
- K+ = hyperkalaemia
- H+ = acidosis
- myoglobin = AKI
