Podcast
Questions and Answers
Which of the following is the most common risk factor for peripheral arterial disease?
Which of the following is the most common risk factor for peripheral arterial disease?
- Hyperlipidaemia
- Elevated CRP
- Smoking (correct)
- Hypertension
What is the most common location in the leg for emboli?
What is the most common location in the leg for emboli?
- Popliteal artery
- Iliac artery
- Subclavian artery
- Bifurcation of the common femoral artery (correct)
What is the characteristic of intermittent claudication?
What is the characteristic of intermittent claudication?
- Cramp-like pain, ache or tiredness brought on by exercise and relieved by rest (correct)
- Pain at rest, ulceration or gangrene
- Reproducible, resolves within 2 – 5 mins rest and recurs at consistent walking distances
- Pain over distal forefoot requiring patient to hang his or her feet over the bed
What is the primary indication for using POCUS in the diagnosis of emboli?
What is the primary indication for using POCUS in the diagnosis of emboli?
What is the most common site of artery disease leading to limb ischemia?
What is the most common site of artery disease leading to limb ischemia?
What is the term for the end of the spectrum of peripheral arterial disease, characterized by pain at rest, ulceration or gangrene?
What is the term for the end of the spectrum of peripheral arterial disease, characterized by pain at rest, ulceration or gangrene?
Which of the following is a cause of embolism?
Which of the following is a cause of embolism?
What is the significance of an ABI value of less than 0.9?
What is the significance of an ABI value of less than 0.9?
What is the percentage of upper limb acute limb ischemia cases due to thrombosis?
What is the percentage of upper limb acute limb ischemia cases due to thrombosis?
What can occur following restoration of blood flow in acute limb ischemia?
What can occur following restoration of blood flow in acute limb ischemia?
What is the most commonly affected artery in the upper limb for emboli?
What is the most commonly affected artery in the upper limb for emboli?
What is the significance of an ABI value greater than 1.3?
What is the significance of an ABI value greater than 1.3?
What is the most common cause of acute limb ischemia?
What is the most common cause of acute limb ischemia?
What is the characteristic of acute limb ischemia?
What is the characteristic of acute limb ischemia?
What is the purpose of checking for hypercoagulable state?
What is the purpose of checking for hypercoagulable state?
What is the significance of Duplex USG in the diagnosis of peripheral arterial disease?
What is the significance of Duplex USG in the diagnosis of peripheral arterial disease?
What is the gold standard for diagnosing ALI?
What is the gold standard for diagnosing ALI?
What is the primary goal of anticoagulation therapy in ALI?
What is the primary goal of anticoagulation therapy in ALI?
What is an alternative to heparin in ALI treatment?
What is an alternative to heparin in ALI treatment?
What is a complication of reperfusion in ALI?
What is a complication of reperfusion in ALI?
What is the recommended treatment for intermittent claudication?
What is the recommended treatment for intermittent claudication?
What is the definition of Rutherford Criteria?
What is the definition of Rutherford Criteria?
What is a definitive treatment for ALI?
What is a definitive treatment for ALI?
What is a possible complication of reperfusion in ALI?
What is a possible complication of reperfusion in ALI?
Study Notes
Acute Limb Ischemia (ALI)
- Definition: Sudden decrease in blood supply to a limb, leading to tissue hypoperfusion and threatening limb viability
- Causes:
- Embolism: less common, often from cardiac sources (e.g., atrial fibrillation)
- Thrombosis: majority of ALI cases, can occur in native vessels and bypass grafts
- Non-cardiac sources: aneurysms, atheromatous plaque, autoimmune disorders, etc.
Risk Factors for Peripheral Arterial Disease (PAD)
- Smoking and diabetes
- Additional risk factors: hyperlipidaemia, hypertension, elevated blood homocysteine, and elevated CRP
Clinical Features
- Intermittent claudication: cramp-like pain, ache, or tiredness brought on by exercise and relieved by rest
- Acute limb ischemia: pain over distal forefoot requiring the patient to hang their feet over the bed, suggestive of severe arterial occlusion
Diagnosis
- Imaging: POCUS, ECHO, Duplex USG, CTA contrast, MRI, and invasive angiogram
- Labs: cellular ischemia markers (CK, myoglobin, lactate), inflammatory markers (WCC, CRP, ESR), and hypercoagulable state screen
Rutherford Criteria (Prognostic Stratification of clinical stages of ALI)
- Classification of ALI into three categories: viable, threatened, and irreversible
Management
- Anticoagulation: IV unfractionated heparin or alternative anti-coagulants
- Definitive treatment: catheter-directed thrombolysis, percutaneous mechanical thrombolectomy, revision of an occluded bypass graft, and revascularization
- Treatment of intermittent claudication: cilostazol (phosphodiesterase inhibitor)
Complications
- Reperfusion Injury: metabolic derangement, compartment syndrome, rhabdomyolysis, arrhythmia, renal failure, and acute tubular necrosis
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Description
This quiz covers the approach and management of acute limb ischemia, including its definition, risk factors, and diagnosis. It also touches on critical limb ischemia and its relationship to peripheral arterial disease.
