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CR - Peripheral Arterial Disease (ii) (acute limb ischaemia (signs +…
CR - Peripheral Arterial Disease (ii)
lower limb ischaemia management principles
individual patient assessment
multi-disciplinary approach
appropriate + timely interventions
try to avoid amputation
acute limb ischaemia
do ECG because if they've had an MI they're unsuitable for surgery
vasc trauma (e.g. long bones break in RTA + damage surrounding vessels)
important to distinguish a thrombus vs embolus as Tx is different
signs + symptoms (6 Ps)
pain
pallor
pulseless
paraesthesia
perishing cold
paralysis (too late to save limb @ this stage)
urgent intervention required
aetiology
thrombosis
patient often has long hx of intermittent claudication
bypass graft occlusion
popliteal aneurysm
on a preexisting atherosclerotic lesion
embolic
80% A fib
10% MI
10% aneurysm
usually a cardiac source
trauma/iatrogenic
ddx
chronic ischaemia
dissection
meningococcal septicaemia
vasospastic disorders
phlegmasia abla dolens (milk/white leg)
part of disease spectrum related to DVT
CHF
Tx of acute limb ischaemia
based on aetiology/severity of ischaemia/predicted outcome
resuscitation
heparinisation (buys time prevents further ischaemia)
open surgery
thomboboembolectomy/bypass
fogarty balloon inflated with saline
ensures flow
check for back bleeding after using doppler
thrombolysis
TPA (tissue plasminogen activator infusion over 24 hrs)
after use balloon to correct chronic narrowing
endovasc options