Acute Limb Ischaemia

Effects of sudden arterial occlusion depends on state of collateral supply
Collateral supply in leg usually inadequate unless pre-existing occlusive disease

Causes of Acute Limb Ischaemia

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

Heparinise & analgesia
Treat associated cardiac disease
Treatment options are
- Embolic disease - embolectomy or intra-arterial thrombolysis
- Thrombotic disease - intra-arterial thrombolysis / angioplasty or bypass surgery

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