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Acute on chronic limb ischemia


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Acute on chronic limb ischemia

  1. 1. By:Farah Adibah KasminUndergraduate UiTM
  2. 2.  Definition: Sudden and rapid worsening symptoms and signs (<14 days) (ABC of Arterial and Venous Disease, BMJ. 2000 April 8; 320(7240): 991) It is caused by a thrombus superimposed on an arteriosclerotic stenoses (Clinical distinction of acute and acute on chronic leg ischaemia, Kauhanen P etc, Fourth Department of Surgery, Helsinki University Central Hospital, Finland) Predisposing factors to acute thrombosis1. Dehydration2. Hypotension3. Unusual posture or activity4. Malignancy5. Hyperviscosity6. Thrombophilia
  3. 3. Clinical features Embolus Thrombosis Complete (noSeverity Incomplete (collaterals) collaterals)Onset Seconds or minutes Hours or daysLimb affected Leg 3:1 arm Leg 10:1 armEmbolic source Present (Ex: AF) AbsentPrevious claudication Absent PresentPalpation of artery Soft, tender Hard, calcifiedBruits Absent PresentContralateral leg Present AbsentpulsesDiagnosis Clinical AngiographyTreatment Embolectomy, warfarin Medical, bypass, thrombolysis
  4. 4. ManagementGeneral Life threatening medical conditions Assess airway, breathing and circulation, and resuscitate as required Oxygen to improve oxygen supply to leg Adequate analgesia:morphine with an anti-emetic Correct fluid & electrolyte imbalance Start anticoagulation: Bolus IV unfractionated heparin and infusion Catheterize and monitor input/outputDefinitive Conservative : anticoagulation only Thrombolytic therapy- streptokinase, urokinase, rTPA Arterial Reconstruction- Bypass Endovascular- angioplasty, stents, aspiration devices Combination of the above