Acute limb ischaemia
Acute limb ischaemia is a sudden decrease in limb perfusion that causes a time-critical threat to limb viability.
•Acute limb ischaemia may be due to thrombosis, embolism, or rarely Dissection
✓Risk factors:
Atrial fibrillation
Recent myocardial infarction
Aortic atherosclerosis
Large vessel aneurysmal disease
Prior lower extremity revascularization
Risk factors for aortic dissection
Arterial trauma
Deep vein thrombosis
✓signs
5Ps:
pain, pallor, pulselessness, paraesthesia and paralysis.
✓diagnosis :
Duplex ultrasonography
CT angiography
Angiography in OT
✓management :
1-In the ED treatment would include:
Correction of dehydration with IV fluids
Keeping the patient NBM in anticipation of further intervention
Analgesia
IV heparin
2-Definitive treatment would depend on the viability if the limb, aetiology and location of the lesion, surgical preference and patient suitability for surgery:
-Peripheral occlusions in a viable limb may be managed by catheter directed thrombolysis, whereas revascularisation of the threatened limb is more time critical.
-Surgical options include:
Embolectomy (catheter or open)
Bypass (if arterial thrombosis present)
-Treatment of the non-viable limb is amputation.