Acute Limb Ischaemia: Case Report

2018

Acute limb ischaemia is both a limb-threatening and life-threatening surgical emergency. The clinical presentation of acute limb ischaemia can vary depending on the underlying aetiology as well as pathophysiology. While traumatic acute limb ischaemia becomes obvious in a trauma victim, nontraumatic ischaemia can be easily mistaken for other neurological or medical conditions. The rapidity with which acute limb ischaemia causes irreversible muscle injury signifies the importance and urgency of accurate diagnosis. A high degree of clinical suspicion and accurate bed-side assessment can be pivotal in timely diagnosis and initiation of definitive care to maximize limb salvage.

Acute Limb Ischaemia (ALI) can be a devastating clinical emergency with potentially life or limb threatening consequences. The commonest aetiologies of ALI are traumatic, embolic or thrombotic. While traumatic ALI is fairly obvious in the trauma victim, embolic and thrombotic ALI may mimic other clinical conditions such as neurological disease which may cause delays in diagnosis. Immediate diagnosis, accurate assessment of limb viability and urgent intervention when needed play a crucial role in salvaging the affected limb and preventing a major amputation. Delay in diagnosis and intervention causes irreversible muscle ischaemia leading to eventual limb loss and potential systemic organ dysfunction due to associated lactic acidosis and other toxins.

British Journal of Surgery, 1997

British Journal of Surgery, 1998

Background Much attention has been paid to the management of acute leg ischaemia. Acute arm ischaemia is perceived as less of a problem because the risk of limb loss is lower. After conservative treatment up to half the patients have late symptoms, such as forearm claudication. Methods This study was a review of all published English language data on acute arm ischaemia. The entire Medline database was searched and other references were derived from the material perused. There were no randomized or controlled studies. Results The incidence of acute arm ischaemia is one-fifth that of acute leg ischaemia. Patients with arm ischaemia tended to be older with a mean age of 74 years compared with 70 years for acute leg ischaemia. Since the development of the embolectomy catheter, embolectomy can be performed in most patients under local anaesthetic. Collected outcome included successful restoration of the circulation in 65-94 per cent of patients and amputation in 0-18 per cent. The mortality rate ranged from 0 to 19 per cent, despite the use of local anaesthesia, mostly from associated cardiac disease. Management by a vascular specialist may be beneficial, particularly in complex cases. Conclusion An active approach to the management of acute arm ischaemia is safe and effective and reduces the risk of late disabling symptoms.

Acute Limb Ischaemia (ALI) can be a devastating clinical emergency with potentially life or limb threatening consequences. The commonest aetiologies of ALI are traumatic, embolic or thrombotic. While traumatic ALI is fairly obvious in the trauma victim, embolic and thrombotic ALI may mimic other clinical conditions such as neurological disease which may cause delays in diagnosis. Immediate diagnosis, accurate assessment of limb viability and urgent intervention when needed play a crucial role in salvaging the affected limb and preventing a major amputation. Delay in diagnosis and intervention causes irreversible muscle ischaemia leading to eventual limb loss and potential systemic organ dysfunction due to associated lactic acidosis and other toxins.

Journal of Clinical Medicine, 2019

This review presents an update on the diagnosis and management of acute limb ischemia (ALI), a severe condition associated with high mortality and amputation rates. A comprehensive spectrum of ALI etiology is presented, with highlights on embolism and in situ thrombosis. The steps for emergency diagnosis are described, emphasizing the role of clinical data and imaging, mainly duplex ultrasound, CT angiography and digital substraction angiography. The different therapeutic techniques are presented, ranging from pharmacological (thrombolysis) to interventional (thromboaspiration, mechanical thrombectomy, and stent implantation) techniques to established surgical revascularization (Fogarty thrombembolectomy, by-pass, endarterectomy, patch angioplasty or combinations) and minor or major amputation of necessity. Postprocedural management, reperfusion injury, compartment syndrome and long-term treatment are also updated.

European Journal of Vascular and Endovascular Surgery, 1999

on behalf of the "i.c.a.i." (CLI) Group (gruppo di studio dell'ischemia cronica critica degli arti inferiori) *

British Journal of Surgery, 1991

Thrombolytic therapy in the management of acute limb ischaemia Acute limb ischaemia poses a threat to both the limb and life of a patient. Until recently, attempted revascularization by thromboembolectomy or vascular reconstruction held the best chance of limb salvage. Thrombolytic techniques afford an alternative method of management for this condition and are effective in selected patients. Low-dose intra-arterial streptokinase is the most established method of thrombolysis, although the recently developed tissue plasminogen activator offers a promising alternative. Intra-arterial thrombolysis is not an easy option, being labour intensive and requiring close cooperation between surgeon and radiologist. Thrombolytic and surgical techniques are not mutually exclusive but are best used to complement each other. Ideally patients with acute limb ischaemia should be managed by surgeons with knowledge of, and access to, optimal current surgical and non-surgical techniques.

Perfusion, 2014

ing therapies might, therefore, reduce morbidity. Clinical IR interventional studies are widely performed in patients with elective ischaemia, e.g. orthopaedic tourniquet surgery 6,8-10 or transplantations or in acute ischaemia, e.g. acute myocardial infarction. The studies apply a variety of interventions, such as antioxidative treatment (N-acetyl cysteine, vitamin C), ischaemic preconditioning, anaesthetic intervention

European Journal of Vascular and Endovascular Surgery, 1997

The i.c.a.i. Group (gruppo di studio dell'ischemia cronica critica degli arti inferiori)*