Acute lower limb ischemia
Acute lower limb ischemia is a serious disease with high morbidity and mortality if left untreated. There are about 150 cases of this disease on 1 million inhabitants per year. It is sudden disease that can lead to an amputation of a limb because of low blood flow and perfusion of the tissues. There are two basic causes of this disease. It is embolisation into the arteries of the limbs and in-situ thrombosis on a plaque of atherosclerosis. Correct diagnosis and early started therapy influence prognosis of the patients. You can solve a diagnosis, treatment, complications and following therapy in our algorithm.
Review
The algorithm Acute lower limb ischaemia is really distinctive. This disease is really frequent and the incidence is about 14-15/ 100 000 inhabitants. Muscular toleration of ischaemia is appoximately 3 hours and that is why we have to think about this diagnosis and start to solve it during the transpost into the hospital as we can see in this algorithm. In practice we can see 2 most frequent mistakes. The first one is that every patient with sudden pain of the lower limb is transported to the specialized vascular surgery as an acute limb ischaemia without an examination of the pulsation. Peripheral pulsation exclude an acute ischaemia, but chronical peripheral arterial disease is possible. Good thing is that there is no delay, because acute lower limb ischaemia requires the fastest diagnosis and treatment of all of the possible causes of a limb pain. However the examination on the vascular surgery is uselessly urgent. The second mistake is diagnosing vein thrombosis and the patient comes with the vein and not the arterial examination. In this algorithm the case is really practical. This algorithm describes how it should be but not real practice. The worth thing of this algorithm is that it shows the treatment of acute limb ischaemia means only the beginning of the patient's care- we have to do next examinations to find out the cause of the ischaemia, controls and set up the efficient therapy (atrial fibrilation or other dysrrhytmia, atherosclerosis , antioedematous therapy if there is an indication of fasciothomy).
Sources
Odb. as. MUDr. Čertík, Bohuslav Ph.D. a Prof. MUDr. Vladislav Třeška DrSC..Akutní končetinová ischémie. První vydání. Praha: Grada, 2003. ISBN 978-80-247-6305-7.
Morrison, III, Harry L., M.D., Ph.D.. Catheter-Directed Thrombolysis for Acute Limb Ischemia.Seminars in Interventional Radiology [online].[New York (USA)]: Semin intervent Radiol 2006; 23(3): 258-269 , DOI: 10.1055/s-2006-948765[vid. 28.10.2015] Dostupnost:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036379/
Robertson, I., Kessel, O., Berridge, DC., Fibrinolytic agents for peripheral arterial occlusion [online]. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD001099. DOI: 10.1002/14651858.CD001099.pub2. [vid. 28.10.2015] Dostupnost:http://www.ncbi.nlm.nih.gov/pubmed/20238313
Peeters, P., Verbist, J., Keirse, K., Deloose, K., Bosiers, M.J., Endovascular managment of acute limb ischemia[online]. [Belgium]:The Journal of Cardiovascular Surgery 2010 June;51(3):329-36, PMID: 20523282 [vid. 28.10.2015] Dostupnost:http://www.ncbi.nlm.nih.gov/pubmed/20523282
