Acute and Chronic Limb Ischemia pptx - D. Ahmed Abd Almeer

ACUTE ARTERIAL OCCLUSION(Acute Limb Ischemia )

By
Dr.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

Chronic limb ischemia

By
Dr.Ahmed Abdul-Ameer Daffar
( ( Cardio-Thoracic & Vascular Surgeon

Asymptomatic

Intermittent claudication
Rest pain
Ischemic ulceration
The end stage of vascular insufficiency is frank tissue infarction or gangrene.

Clinical evaluation

Features of chronic ischemia

Absent distal pulse
Muscle atrophy
Brittle nails
Hair loss
Etc…

Physical Examination

Reduced ABI
Color duplex scanning
Traditional angiography
CTA
MRA
Investigations

Conservative measures

Control of Hypertension, hyperlipidemia and D.M.
Smoking abstinence
Graduated exercise program
Control of weight
Pharmacologic agents
Platelet inhibitors such as aspirin
Vasodilating agents such as tolazoline
Hemorrheologic agents such as pentoxifylline
Treatment

Percutaneous Trans-luminal Angioplasty
Bypass surgery
Endarterectomy
Amputation ( last option )