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.
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