Arterial Diseases:

 Acute limb ischemia:

o Sudden decrease in limb perfusion within 2 weeks
 Embolic vs thrombosis
 Claudication history
 History of AMI/CVA/AF
 Physical findings (Contralateral pulses, presence of collaterals,
colour – dusky vs pale)
 Angiography (presence of collaterals, atherosclerosis and irregular
cut-off)
 Treatment:
o Embolic:
 Embolectomy with fogarty balloon post-op look
out for compartment syndrome secondary to
reperfusion injury  three compartment
fasciotomy
 ECG to check for arrhythmias predisposition
o Thromobosis:
 Thrombolysis with tPA, streptokinase
 Angioplasty
 Stenting
 Determinng severity: Viable vs Threatened vs Non-viable
 Motor
 Sensory
 Pain
 Cap Refill
 Arterial Doppler
 Venous Doppler
 Management:
 Doppler U/S
 IV Heperin 5000U stat dose followed by 1000U/hr
 Analgesia
 Keep legs perfused
o O2 supplementation
o Keep legs dependent
o Correct hypoperfusion
 Treat reversible causes
 Blood investigation:
o PT/PTT, GXM, FBC, UECr, LFT, CXR, ECG
 Angiogram

o DDx:
 Acute DVT
 Phelgmesia alba dolens/cerulean dolens


o Presentation:
 Pain
 Paresthesia
 Pallor  Dusky  Mottling  fixed staining (Non-viable)
 Pulseless
 Perishing cold
 Paralysis
 Critical limb ischemia:
o Presence of rest pain +/- evidence of tissue loss
o Decrease in limb perfusion that poses threat to limb viability that is more than 2
weeks after acute event
o Features:
 Rest pain
 Objective indication:
 ABI <0.5 (<55mmHg)
 TBI<0.3 (<30mmHg)
 Ischemic ulcer
 Gangrene