FN: Acute Limb Ischaemia Flashcards Preview

Final Notes > FN: Acute Limb Ischaemia > Flashcards

Flashcards in FN: Acute Limb Ischaemia Deck (29):
1

Acute definition

2

Acute definition

3

Acute on chronic

Worsening symptoms and signs

4

Chronic

Ischaemia stable for >14d

5

Severity

Incomplete: limb not threatened
Complete: lib threatened - loss of limb unless intervention w/i/6hrs
Irreversible: requires amputation

6

Causes

Thrombosis in situ
Embolism
Graft/stent occlusion
Trauma
Aortic dissection

7

Thrombosis in situ (60%)

A previously stenosed vessel with plaque rupture
Usually incomplete ischaemia

8

Embolism (30%)

1. 80% form LA to AF
2. Valve disease
3. iatrogenic form angioplasty/surgery
4. Cholesterol in long bone fracture
5. Paradoxical (venous via PFO)
6. typically lodge at femoral bifurcation
7. Often complete ischaemia

9

Presentation:6Ps

Pale
Pulseless
Perishingly cold
Painful
Parasthesia
Paralysis

10

Emobolus
Onset
Severity
Embolic source
Caludication Hx
Contralat pulses
Dx
Rx

Sudden
Profound ischaemia
Present - often AF
Absent
Present
Clinical
Embolectomy + Warfarin

11

Chronic

Ischaemia stable for >14d

12

Severity

Incomplete: limb not threatened
Complete: lib threatened - loss of limb unless intervention w/i/6hrs
Irreversible: requires amputation

13

Causes

Thrombosis in situ
Embolism
Graft/stent occlusion
Trauma
Aortic dissection

14

Thrombosis in situ (60%)

A previously stenosed vessel with plaque rupture
Usually incomplete ischaemia

15

Embolism (30%)

1. 80% form LA to AF
2. Valve disease
3. iatrogenic form angioplasty/surgery
4. Cholesterol in long bone fracture
5. Paradoxical (venous via PFO)
6. typically lodge at femoral bifurcation
7. Often complete ischaemia

16

Presentation:6Ps

Pale
Pulseless
Perishingly cold
Painful
Parasthesia
Paralysis

17

Thombosis
Onset
Severity
Embolic source
Caludication Hx
Contralat pulses
dx
Rx

1. Hrs-days
2. Less severe - collaterals
4. Present
5. Absent
6. Angiography
7. Thrombolysis
Bypass surgery

18

OTher options

Emergency reconstruction
Amputation

19

Investigations

Bloods: FBC, U+E, INR, G+S, CK
ECG
Imaging: CXR, Duplex doppler

20

General Mx

In an acutely ischaemic limb discuss immediately with a senior as tim eis crucial
NBM
Rehydration: IV fluids
analgesia: morphine + metoclopramide
Abx: e.g. augmentin if sgns of infection
Unfractionated heparin IVI: prevent extension

21

Complete occlusion Mx

Yes: uregent surgery: embolectomy or bypass
No: agiogram + observe for deterioration

22

Angiography

Not performed if there is complete occlusion as it introduces delay: take straight to theatre

If incomplete occlusion, pre-op angio wil guide any distal bypass

23

Embolus management

Embolectomy
thrombolysis
Other otpions

24

Embolectomy

LA or GA
Wire fed through embolus
Fogarty catheter fed ocer the top
Balloon inflated and caether withdraw, reomving the embolsim
Send embolis for histo (exclude atrial myxoma)
Adequacy confirmed by on-table angiography

25

thrombolysis

Consider if embolectomy unsuccessful
e.g. local injectino of TPA

26

OTher options

Emergency reconstruction
Amputation

27

Post-embolectomy

1. Anticoagulate: heparin IVI - warfarin
ID embolic source: ECG, echo, US aorta, fem and pop

28

Complication spost-embolectomy

Reperfusion injury
1. Local swelling - compartment syndrome
2. Acidosis and arrhythmia secondary to potassium increased
3. ARDS
4. GI oedema: endotoxic shock

Chronic pain syndromes

29

thombosis Mx

Emergency reconstruction if complete occlusions
angiography _ angioplasty
Thrombolysis
Amputation

Decks in Final Notes Class (196):