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DEFINITION
Acute limb ischaemia results from sudden interruption of the limb blood supply by thrombus,
embolus or trauma. It carries a high morbidity, including loss of limb. There are two major
categories:
Acute limb ischaemia
RISK FACTORS
Diabetes
Hypertension
Hypercholesterolaemia
Smoking
Pre-existing PVD
AAA/popliteal aneurysm
Atrial fibrillation
ASSESSMENT
Ask about:
claudication
night pain
previous tissue necrosis (e.g. ulcers)
Determine site of occlusion
check presence of all peripheral pulses, including abdominal aortic pulse
assess quality and regularity of pulse, noting AF in particular
auscultate for bruits (e.g. subclavian, axillary, femoral)
Grade I
Variable
Grade II
Threatened
Grade III
Irreversible
Painful, tender
calf/painful plantar flexion
No neurosensory deficit
INVESTIGATIONS
Bloods:
FBC, U&E
INR, APTT, platelet count, group & save
creatine kinase
ECG
Chest X-ray
Ankle Brachial Pressure Index (ABPI)
If aneurysm suspected
abdominal USS
duplex Doppler scan of popliteal arteries
IMMEDIATE TREATMENT
General
Assess airway, breathing and circulation, and resuscitate as required
Give oxygen, starting with a 24% Venturi mask to improve oxygen supply to leg
Give adequate analgesia
Neurosensory deficit
No
Yes
IV heparin
No
Vascular surgical opinion and
angiography
(next day, if out-of-hours)
Probable embolus
Proceed to embolectomy
Urgent vascularopinion
Consider Duplex Doppler and/or angiography
SUBSEQUENT MANAGEMENT
diet
Treat hypertension and/or raised cholesterol appropriately
Ensure appropriate out-patient follow-up with vascular team