ACUTE ARTERIAL OCCLUSION(Acute Limb Ischemia )
ByDr.Ahmed Abdul-Ameer Daffar
( Cardio-Thoracic &Vascular Surgeon )
Definition
Sudden cessation of limb perfusion.Etiology
Embolism. The heart is the most common source of distal emboli, which account for more than 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
Acute Limb ischemia manifests with the “six Ps":Pain
Pallor
Paralysis
Paresthesia
Pulselessness
Poikilothermia
The 6 Ps
• Treatment
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.
Fogarty Catheter
Embolus
Amputation may be indicated in established gangrene.
Patients with prosthetic limbs
