Acute arterial ischemia - Revision history

Danbot: Add MedicationDose entry (heparin) with SMW annotations

2026-03-20T18:52:36Z

Add MedicationDose entry (heparin) with SMW annotations

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 **Management of thrombus = intra-arterial thrombolysis (if non-limb threatening), thrombectomy (if limb-threatening ischmia)
 *Interventional radiology if delay in vascular surgery intervention or if unavailable
 ==Disposition==

2023-05-03T18:22:42Z

Background

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	==Background==		==Background==
			[[File:Arterial System en.png\|thumb\|Major arteries of the body.]]
	*Sudden decrease in perfusion that may result in irreversible limb loss		*Sudden decrease in perfusion that may result in irreversible limb loss
	**Amputation occurs in 10%-15% of patients during hospitalization<ref>Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-S67. doi:10.1016/j.jvs.2006.12.037</ref>		**Amputation occurs in 10%-15% of patients during hospitalization<ref>Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-S67. doi:10.1016/j.jvs.2006.12.037</ref>

2021-09-19T03:13:29Z

External Links

← Older revision		Revision as of 03:13, 19 September 2021
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	==External Links==		==External Links==
			*[http://www.emdocs.net/acute-limb-ischemia-pearls-pitfalls/ emDOCS - Acute Limb Ischemia: Pearls and Pitfalls]

	==References==		==References==

2021-09-19T03:05:46Z

Disposition

← Older revision		Revision as of 03:05, 19 September 2021
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	==Disposition==		==Disposition==
	*~~Admit~~		===Admission===
			*Patients with an ABI of <0.5 warrant admission after immediate consultation with vascular surgery

			===Discharge===
			*Patients with stable ABI measurements, resolved pain, and chronic occlusive disease can be discharged with vascular surgical follow-up.

	==See Also==		==See Also==

2021-07-24T12:20:05Z

Clinical Features

← Older revision		Revision as of 12:20, 24 July 2021
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	==Clinical Features==		==Clinical Features==
			[[File:Arterial thrombosis causing cyanosis.jpg\|thumb\|Acute embolism to the right femoral artery resulting in ischemia.]]
	{{6Ps}}		{{6Ps}}

2021-07-24T12:18:54Z

Evaluation

← Older revision		Revision as of 12:18, 24 July 2021
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	===Imaging===		===Imaging===
			[[File:Acuteoccluisionaxartery.png\|thumb\|Acute occlusion of the axillary artery resulting in an ischemic limb as seen on CT angiography.]]
	*Formal angiogram considered gold standard		*Formal angiogram considered gold standard
	*CTA as a diagnostic is near the level of formal angiography (96% sensitive, 95% specific)<ref>Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol. 2013;23(11):3104-3114. doi:10.1007/s00330-013-2933-8</ref>		*CTA as a diagnostic is near the level of formal angiography (96% sensitive, 95% specific)<ref>Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol. 2013;23(11):3104-3114. doi:10.1007/s00330-013-2933-8</ref>

2021-07-24T12:16:02Z

Rutherford Classification

← Older revision		Revision as of 12:16, 24 July 2021
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	\|}		\|}

	===Rutherford Classification~~===~~		===Rutherford Classification<ref>Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg 2009;22:5-9.</ref>===
	~~[[File~~:~~rutherford classification~~.~~PNG\|400px]]~~
	~~[[File~~:~~Rutherford classification~~.~~png\|thumb\|Rutherford Classfication]]~~
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''Category'''		\| align="center" style="background:#f0f0f0;"\|'''Category'''

2021-07-24T12:14:18Z

Rutherford Classification

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 [[File:rutherford classification.PNG|400px]]
 [[File:Rutherford classification.png|thumb|Rutherford Classfication]]
 ==Management==

2021-06-25T01:56:50Z

Evaluation

← Older revision		Revision as of 01:56, 25 June 2021
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	*CTA as a diagnostic is near the level of formal angiography (96% sensitive, 95% specific)<ref>Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol. 2013;23(11):3104-3114. doi:10.1007/s00330-013-2933-8</ref>		*CTA as a diagnostic is near the level of formal angiography (96% sensitive, 95% specific)<ref>Jens S, Koelemay MJ, Reekers JA, Bipat S. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis. Eur Radiol. 2013;23(11):3104-3114. doi:10.1007/s00330-013-2933-8</ref>
	*US is sensitive for proximal extremity occlusions, but sensitivity markedly falls off distally and is operator dependent		*US is sensitive for proximal extremity occlusions, but sensitivity markedly falls off distally and is operator dependent

			===Laboratory Evaluation===
			*Not useful for diagnosis, but essential for monitoring co-existing conditions and response to anticoagulant therapy. Should include:
			**CBC
			**BMP
			**PT/PTT
			**Creatine kinase

	===Thrombosis vs Embolus===		===Thrombosis vs Embolus===

2021-06-25T01:49:28Z

Background

← Older revision		Revision as of 01:49, 25 June 2021
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	*Sudden decrease in perfusion that may result in irreversible limb loss		*Sudden decrease in perfusion that may result in irreversible limb loss
	**Amputation occurs in 10%-15% of patients during hospitalization<ref>Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-S67. doi:10.1016/j.jvs.2006.12.037</ref>		**Amputation occurs in 10%-15% of patients during hospitalization<ref>Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-S67. doi:10.1016/j.jvs.2006.12.037</ref>
	*Etiology may be thrombotic or embolic		*Etiology may be thrombotic (80%) or embolic (20%)<ref>Mitchell ME, Carpenter JP. Overview of acute arterial occlusion of the extremities (acute limb ischemia). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-acute-arterial-occlusion-of-the-extremities-acute-limb-ischemia?source=search_result&search=Classification%20of%20acute%20extremity%20ischemia&selectedTitle=1~90#H506059593.Last updated: May 30, 2016. Accessed: December 12, 2016.</ref>
	**Thrombosis occurs in vessels with existing atherosclerosis		**Thrombosis occurs in vessels with existing atherosclerosis
	***Generally have formed collateral circulation		***Generally have formed collateral circulation