Escolar Documentos
Profissional Documentos
Cultura Documentos
Ali SABBOUR
Sudden decrease of
arterial limb perfusion
causing threat to limb
viability
Acute Embolic
Ischemia
Patho-pysiology
Acute Thrombotic
Ischemia
An embolus can originate from the heart (MS with atrial fibrillation,
MI with mural thrombus) or dilated diseased arteries (aortic aneurism)
An embolus
suddenly
occludes a
relatively
healthy
arterial tree
It usually
arrest at
arterial
bifurcation
Aortic bifurcation
Iliac bifurcation
Femoral bifurcation
Popliteal trifurcation
Atherosclerosis
causes
progressive
narrowing of the
arterial tree
Stimulates
development of
collaterals
Sluggish flow &
rough surface
will favor acute
thrombosis
Postgraduates
Popliteal artery
Tibial arteries
Definition: Sudden decrease of arterial limb perfusion causing threat to limb viability
Etiology: 1-Embolic (Rh.heart w mitral stenosis & AF or Ischemic heart w acute myocardial
infarction & mural thrombus or extra-cardiac embolism from aneurismal arteries)
2-Thrombotic
Management
5Ps
Pain: symptom
+
Pale
Pulseless
Parathesia
Paralysis
Inspection
COLOR:
Fixed
mottling &
cyanosis
Early: pale
Later: cyanosed
mottling
mottling & cyanosis
fixed
An area of
Pallor
fixed
cyanosis
surrounded by
reversible
Reversible
mottling
mottling
Empty veins:
compare the Rt.
(ischemic) & Lt.
(normal)
Palpation
5Ps
Pain: symptom
Femoral
Popliteal
Posterior tibial
Dorsalis pedis
Pale
Pulseless
Parathesia
Paralysis
5Ps
Pain: symptom
+
Pale
Pulseless
Parathesia
Paralysis
Palpation
Loss of sensory function
Numbness will progress to anesthesia
Progress of Sensory loss
Light touch
Vibration sense
Proprioreception
Deep pain
Pressure sense
Late
5Ps
Pain: symptom
Palpation
Loss of motor function:
Indicates advanced limb threatening
ischemia
Late irreversible ischemia: Muscle turgidity
Pale
Pulseless
Parathesia
Paralysis
Postgraduates
Postgraduates
Prognosis
Sensory
loss
weakness
-ve
-ve
audible
audible
Not immediately
threatened
II.a Marginal
threat
Minimal
sensory loss
No muscle
weakness
Often not
audible
audible
Salvageable if prompt
ttt (there is time for
II.b Immediate
threat
Rest pain w
sensory loss
III.Irreversible
Severe
anesthesia
Class
I. Viable
Motor
Doppler
Arterial Venous
signals Signals
angiography)
Mild to
moderate
Usually
not
audible
audible
Salvageable with
immediate ttt (no time
for angiography)
Not salvageable,
permanent N. & muscle
damage , needs amputation
Definition: Sudden decrease of arterial limb perfusion causing threat to limb viability
Etiology: 1-Embolic (Rh.heart w mitral stenosis & AF or Ischemic heart w acute myocardial
infarction & mural thrombus or extra-cardiac embolism from aneurismal arteries)
2-Thrombotic
Clinical Picture
Management
Doppler US
It is important to look for
arterial Doppler signals
to assess the level of
obstruction & severity of
ischemia
DO ANGIOGRAPHY
Value of angiography
Localizes the obstruction
Visualize the arterial tree & distal
run-off
Can diagnose an embolus:
Sharp cutoff, reversed meniscus or clot
silhouette
Popliteal embolism
Clot silhouette
Contraindications:
Absolute:
1. Cerebro-vascular stroke within previous 2 months
2. Active bleeding or recent GI bleeding within previous 10 days
3. Intracranial trauma or neurosurgery within previous 3 months
Relative:
1. Cardio-pulmonary resuscitation within previous 10 days
2. Major surgery or trauma within previous 10 days
3. Uncontrolled hypertension
Following revascularization:
The sudden return of oxygenated blood to the acutely
ischemic muscles generates & releases oxygen free radicals
that causes cellular injury and severe edema
Compartment syndrome
& muscle necrosis
ttt
Fasciotomy
Longitudinal incision of the skin & deep fascia to release pressure over swollen muscles
Amputation:
Done for irreversible ischemia with permanent tissue
damage (turgid muscles, fixed cyanosis)
The level of amputation is decided according to the level of
palpable pulse.
Definition: Sudden decrease of arterial limb perfusion causing threat to limb viability
Etiology: 1-Embolic (Rh.heart w mitral stenosis & AF or Ischemic heart w acute myocardial
infarction & mural thrombus or extra-cardiac embolism from aneurismal arteries)
2-Thrombotic
Treatment