Acute limb ischemia Aetiology 1 Arterial embolism 2

Acute limb ischemia

Aetiology: 1. Arterial embolism. 2. Acute arterial thrombosis. 3. Other causes: Arterial trauma including intra-arterial drug injection. Aortic dissection. External compression, e. g. , a very tight tourniquet. Compartment syndrome. Extensive iliofemoral DVT (phlegmasia alba dolens).

Arterial embolism: Definition Embolism is the passage of a matter from one part of the circulation to another through a vascular lumen.

Arterial embolism: Causes: 1 - Cardiac: - Arrhythmia: AF - Myocardial infarction: Mural thrombus - Bacterial endocarditis 2 - Non-cardiac: - A thrombus in an aneurysm - Platelet thrombi on top of an ulcerated atherosclerotic plaque.

Pathophysiologyof arterial embolization.

Acute arterial thrombosis

Predisposing factors: - Atherosclerosis - As a complication of arterial aneurysm - Traumatic contusion of vessels - Dehydration.

Clinical consequences: Complete recovery Gangrene Chronic ischemia Volkmann’s ischemic contracture

Sites of emboli.

Clinical features: Pain Paralysis Parasthesia Pallor. Pulselessness Pershing coldness.

Investigations 1 - Doppler flow study 2 - Duplex ultrasound. 3 - Arteriography. 4 - Echocardiography. 5 - Laboratory studies.

Differential diagnosis 1 - Low flow states. 2 - Acute occlusion of femoral or popliteal aneurysm. 3 - Phlegmasia cerulae dolens. 4 - Aortic dissection.

Treatment A- General measures 1 - Morphine for pain 2 - I. V. fluids 3 - I. V. heparin 4 - Care for cardiac condition

Treatment B- Specific measures 1 - Embolism: Urgent embolectomy. 2 - Acute Thrombosis: Thrombolytic treatment. Revascularization procedures: • Thrombectomy. • Bypass.

Treatment B- Specific measures Thrombolytic therapy: - Drugs: • Streptokinase • Tissue plasminogen activator (TPA) - Complications: • Anaphylactic reaction • Hemorrhage

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