Acute Limb Ischaemia

Author: Rosie Darwood / Editor: Jason Kendall / Reviewer: Jon Bailey, Peter Lynas / Codes: A6 / Published: 14/01/2022

Description:

This session covers the diagnosis and initial management of a patient with acute limb ischaemia (ALI).

By the end of this session you will be able to:

  • Recognise & diagnose acute limb ischaemia
  • Initiate appropriate investigations & management of ALI in the ED
  • Recognise the therapeutic relevance of the difference between patients with ALI from embolus and those from thrombus
  • Understand which patients need urgent and which need immediate intervention.
START MODULE

References:

  1. National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. NICE guideline [CG147]. Published: 08 August 2012, Updated: 11 December 2020.
  2. Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012 Jun 7;366(23):2198-206.
  3. Brearley S. Acute Leg Ischaemia. BMJ 2013; 346.
  4. Dormandy J, Heeck L, Vig S. Acute limb ischemia. Semin Vasc Surg. 1999 Jun;12(2):148-53.
  5. Jaff MR, White CJ, Hiatt WR, et al. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Journal of Endovascular Therapy. 2015;22(5):663-677.
  6. Jivegrd L, Wingren U. Management of acute limb ischaemia over two decades: the Swedish experience. Eur J Vasc Endovasc Surg. 1999 Aug;18(2):93-5.
  7. Howard DP, Banerjee A, Fairhead JF, Hands L, Silver LE, Rothwell PM; Oxford Vascular Study. Population-Based Study of Incidence, Risk Factors, Outcome, and Prognosis of Ischemic Peripheral Arterial Events: Implications for Prevention. Circulation. 2015 Nov 10;132(19):1805-15.
  8. Fowkes F, Housley E, Cawood E, Macintyre C, Ruckley C, Prescott R. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 20(2):384-392.
  9. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, C et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001 Sep 19;286(11):1317-24.
  10. Aune S, Trippestad A. Operative mortality and long-term survival of patients operated on for acute lower limb ischaemia. Eur J Vasc Endovasc Surg. 1998 Feb;15(2):143-6.
  11. Eliason J, Wainess R, Proctor M, Dimick J, Cowan J, et al. A National and Single Insitutional Experience in the Contemporary Treatment of Acute Lower Extremity Ischaemia. Ann Surg 2003; 238(3):382-390.
  12. Campbell WB, Ridler BM, Szymanska TH. Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland. Br J Surg. 1998 Nov;85(11):1498-503.
  13. Berridge DC, Kessel D, Robertson I. Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev. 2002;(3):CD002784. doi: 10.1002/14651858.CD002784. Update in: Cochrane Database Syst Rev. 2013;6:CD002784.
  14. Enezate TH, Omran J, Mahmud E, Patel M, et al. Endovascular versus surgical treatment for acute limb ischemia: a systematic review and meta-analysis of clinical trials. Cardiovasc Diagn Ther. 2017 Jun;7(3):264-271.
  15. Kuukasjarvi P, Salenius J, Finnvasc study group. Perioperative Ouctome of Acute Lower Limb Ischaemia on the Basis of the National Vascular Registry. Eur J Vasc Endovasc Surg 1994; 8:578-583.
  16. Campbell WB, Verfaillie P, Ridler BM, Thompson JF. Non-operative treatment of advanced limb ischaemia: the decision for palliative care. Eur J Vasc Endovasc Surg. 2000 Mar;19(3):246-9.
  17. Mercer K, Berridge D, Golden M. Saddle embolus-the need for intensive investigation and critical evaluationq. Vascular Surgery 2001; 35(1):63-65.
  18. Berridge DC, Hopkinson BR, Makin GS. Acute lower limb arterial ischaemia: a role for continuous oxygen inhalation. Br J Surg. 1989 Oct;76(10):1021-3.
  19. Richards T, Pittathankal AA, Magee TR, Galland RB. The current role of intra-arterial thrombolysis. Eur J Vasc Endovasc Surg. 2003 Aug;26(2):166-9.
  20. Eyers P, Earnshaw JJ. Acute non-traumatic arm ischaemia. Br J Surg. 1998 Oct;85(10):1340-6.

Module Content

Expand All

Leave a Reply

BACK TO POST