vascular surgery,

Acute Limb Ischaemia

Apr 11, 2020

Definition

  • Surgical emergency requiring revascularization within 4–6h to save the limb
  • May be due to thrombosis in situ (~40%), emboli (38%), graft/angioplasty occlusion (15%), or trauma
  • Can be at multiple sites
  • Amputation rate: 16%.

Symptoms and signs

  • In patients with known PAD, sudden deterioration of symptoms with deep duskiness of the limb may indicate acute arterial occlusion
  • This appearance is due to extensive pre-existing collaterals and must not be misdiagnosed as gout/cellulitis.
  • The 6 ‘p’s of acute ischaemia: pale, pulseless, painful, paralysed, paraesthetic, and ‘perishingly cold’
  • Onset of fixed mottling implies irreversibility
  • Emboli commonly arise from the heart (AF; mural thrombus) or aneurysms

Management

  • Emergency open surgery or angioplasty
  • If diagnosis is in doubt, do urgent arteriography
  • If embolic occlusion → surgical embolectomy (Fogarty catheter) or local thrombolysis, (t-pa)