Acute limb ischaemia

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.