Acute Limb Ischemia CRT 2012 1 Arterial embolism

Acute Limb Ischemia { CRT 2012

1. Arterial embolism • Embolos or plug • Afib • CHF • Paradoxical • Endocarditis • Cardiac tumor • Atheroembolism • Aortic mural thrombus 2. Arterial thrombosis • Atherosclerosis • Dissection • Bypass graft thrombosis Etiology

Presentation “ 6 P’s” pain, palor, pulselessnes, parasthesia, paralysis, polar

Classification of Acute Limb Ischemia Category Muscle weakness Doppler I Viable None Present II Threatened Mild/Moderate Absent III Irreversible Paralysis Absent Rutherford RB JVS 1997; 26: 517 -538

Imaging Arteriography CTA Duplex MRA

Treatment Immediate anticoagulation Operative Thrombectomy Endovascular Lytic therapy Mechanical thrombectomy Combined therapies

Treatment Operative Thrombectomy

Treatment Fogarty Through the Lumen Balloons

Treatment

Treatment

Treatment Angiojet

Treatment Adjuncts for Lytic Therapy

Complications Myoglobinuria Hydration Alkalization of urine Compartment Syndrome Fasciotomy

Summary Acute limb ischemia requires rapid assessment and treatment to achieve limb salvage. Appreciation of the time -line is a critical factor influencing outcomes Multiple modalities are available including surgical, endovascular and combined therapies for treatment. Complications are frequent and require serial reassessment to prevent limb loss. Careful management of anticoagulation and identification of the embolic source is required for longterm success.