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Acute Limb Ischaemia

Causes of Acute Limb Ischaemia

  • Embolism
    • Left atrium in patients in atrial fibrillation
    • Mural thrombus after myocardial infarct
    • Prosthetic and diseases heart valves
    • Aneurysm or atheromatous stenosis
    • Tumour, foreign body, paradoxical
  • Thrombosis
  • Trauma
  • Dissecting Aneurysm
  • Raynaud's Syndrome
Acute Limb Ischaemia

Clinical Features

  • Clinical diagnosis depends on the 6 'p' s
    • Pain
    • Paraesthesia
    • Pallor
    • Pulselessness
    • Paralysis
    • Poikilothermia
  • Fixed staining is a late sign
  • Objective sensory loss requires urgent treatment
  • Need to differentiate embolism from thrombosis
  • Important clinical features include
    • Rapidity of onset of symptoms
    • Features of pre-existing chronic arterial disease
    • Potential source of embolus
    • State of pedal pulses in contralateral leg
Lower Limb Acute Ischaemia
Upper Limb Acute Ischaemia



Emergency Embolectomy 

Intra-arterial thrombolysis

  • Arteriogram and catheter advanced into thrombus
  • Urokinase 15000u/hr + heparin 250u/hr
  • Alternative thrombolytic agents include urokinase or tissue plasminogen activator (TPA)
  • Repeat arteriogram at 6 -12 hours
  • Advance catheter and continue thrombolysis for 48 hours or until clot lysis
  • Success 60-70% but needs careful case selection
  • Not suitable if severe neuro-sensory deficit
  • Thrombolysis can be accelerated by
    • Pulse spray through multiple side hole catheter
    • Aspiration thrombectomy - debulking thrombus aspiration
    • High dose over shorter time
    • Complications
    • Mortality of 1-2%
    • Bleeding - CVA, retroperitoneal

Late presentation. This limb cannot be salvaged and will need amputation

Dr. Pankaj Patel a vascular surgeon has expertise in peripheral vascular diseases, varicose veins and deep vein thrombosis