ACUTE ARTERIAL OCCLUSION (Acute Limb Ischemia )

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Presentation transcript:

ACUTE ARTERIAL OCCLUSION (Acute Limb Ischemia ) By Dr.Ahmed Abdul-Ameer Daffar ( Cardio-Thoracic &Vascular Surgeon )

Definition Sudden cessation of limb perfusion.

Etiology Embolism. The heart is the most common source of distal emboli, which account for more than 90% of peripheral arterial embolic events. AF being the most common source Myocardial infarction Left ventricular aneurysm Cardiomyopathy Valvular heart disease Subacute bacterial endocarditis Aortic aneurysm Native vessel thrombosis Atherosclerotic plaque rupture Complication of aneurysm Reconstruction thrombosis (ex:-thrombosis of a prosthetic conduit) Trauma Aortic dissection

Pathophysiology The most common cause of acute limb ischemia is embolization and the most common source is the heart and mainly due to AF. The most common site of embolization is the lower limbs. Early intervention may restore limb function and prevent irreversible ischemic changes. Delay of intervention leads to development of irreversible ischemic changes ( gangrene ).

Clinical Manifestations Acute Limb ischemia manifests with the “six Ps": Pain Pallor Paralysis Paresthesia Pulselessness Poikilothermia

Treatment Anticoagulation with heparin is indicated as soon as possible. IV fluid should be started and a Foley catheter inserted to monitor urine output. Baseline labs should be obtained including renal & liver function tests, electrolytes, platelet count, ECG, etc…. Analgesia Embolectomy is indicated before irreversible changes appear in the affected limb. Amputation rather than attempts at revascularization may be indicated in established gangrene.

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