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)