Acute limb ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage (ALI) is a major vascular emergency because of the rapid decrease in limb perfusion that causes a potential threat to limb viability. The majority of cases are caused by arterial thrombosis Thrombosis Formation and development of a thrombus or blood clot in the blood vessel. Epidemic Typhus due to plaque Plaque Primary Skin Lesions progression or embolism, but ALI can also be caused by blockage of the venous drainage. The typical signs and symptoms of ALI are often referred to as the 6 Ps PS Invasive Mechanical Ventilation: pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, pallor, poikilothermia, paralysis, paresthesia, and pulselessness Pulselessness Cardiac Arrest. The diagnosis is made on the basis of clinical findings and Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) studies, but additional imaging may be required. Management is focused on revascularization Revascularization Thromboangiitis Obliterans (Buerger’s Disease). IV heparin is also administered. Nonviable limbs require amputation Amputation An amputation is the separation of a portion of the limb or the entire limb from the body, along with the bone. Amputations are generally indicated for conditions that compromise the viability of the limb or promote the spread of a local process that could manifest systemically. Amputation.
Last updated: 16 Jun, 2022
Acute limb ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage (ALI) is a vascular emergency caused by a rapid decrease in limb perfusion.
Skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions changes and ulcers in a patient with type 2 Type 2 Spinal Muscular Atrophy diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus and peripheral artery disease Peripheral artery disease Peripheral artery disease (PAD) is obstruction of the arterial lumen resulting in decreased blood flow to the distal limbs. The disease can be a result of atherosclerosis or thrombosis. Patients may be asymptomatic or have progressive claudication, skin discoloration, ischemic ulcers, or gangrene. Peripheral Artery Disease
Image: “ Skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions ulcers on the right foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy” by Manevska N, Gjorceva DP, Ahmeti I, Todorovska L, Stojanoski S, Kocovska MZ. License: CC BY 2.5Unrecognized
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy
ischemia
Ischemia
A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation.
Ischemic Cell Damage after intraarterial drug injection:
Note the significant bluish discoloration of the ischemic right
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy distal to the wrist. The patient presented with hypoesthesia distal to the wrist crease and a pathologic
Allen test
Allen test
With simultaneous compression of the radial and ulnar arteries, the hand remains pale after alternately releasing.
Thromboangiitis Obliterans (Buerger’s Disease).
Full-thickness necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the heel due to acute limb ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage in a diabetic patient
Image: “Full thickness necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage due to acute limb ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage” by Bingol UA, Cinar C, Arslan H, Altındas M. License: CC BY 3.0Acute limb ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage is diagnosed on the basis of medical history, clinical presentation, physical examination, and vascular imaging.
Assess for the 6 Ps PS Invasive Mechanical Ventilation:
Intraoperative angiogram:
A: Superficial femoral and
popliteal artery
Popliteal Artery
The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries.
Popliteal Fossa: Anatomy occlusion
B: Femoropopliteal predilatation
C: Postprocedural result after
plaque
Plaque
Primary Skin Lesions excision with TurboHawk
The treatment approach depends on the severity or category of ischemic injury:
Complications: