1
ACUTE ARTERIAL OCCLUSION
Definition
Sudden loss of limb or organ perfusion
Etiology of Acute Limb Ischemia
-
Embolism.
The heart is the most common source of distal emboli, which account for
more than70- 90% of peripheral arterial embolic events.
AF being the most common source
Myocardial infarction
Left ventricular aneurysm
Cardiomyopathy
Valvular heart disease
Subacute bacterial endocarditis
Aortic aneurysm
-
Native vessel thrombosis
Atherosclerotic plaque rupture
Complication of aneurysm
-
Reconstruction thrombosis
(ex:-thrombosis of a prosthetic conduit)
- Trauma
- Aortic dissection
Pathophysiology
The most common cause of acute limb ischemia is embolization and the most
common source is the heart and mainly due to AF. The most common site of
embolization is the lower limbs. Early intervention may restore limb function and
prevent irreversible ischemic changes. Delay of intervention leads to development of
irreversible ischemic changes ( gangrene ).
Clinical Manifestations of Acute Limb Ischemia
Acute LE ischemia manifests with the "five
P
s":
p
ain
,
p
allor
,
p
aresthesias
,
p
aralysis
, and
p
ulselessness
, to which some add a sixth "P"—
p
oikilothermia
.
Treatment Considerations for Acute Limb Ischemia
- Anticoagulation with heparin is indicated as soon as possible.
- IV fluid should be started and a Foley catheter inserted to monitor urine output.
- Baseline labs should be obtained including renal & liver function tests,
electrolytes, platelet count, ECG, etc….
-
Analgesia
- Embolectomy is indicated before irreversible changes appear in the affected limb.
- Catheter based lysis with angioplasty or bypass graft if embolectomy failed
2
Amputation rather than attempts at revascularization may be indicated in
established gangrene