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TẮC ĐỘNG MẠCH NUÔI CHI cấp TÍNH (NGOẠI cơ sở)
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Peripheral Vascular
Disease
Acute Limb Ischemia
Lipi Shukla
Target
1.Diagnosis
2.Management
3.Emergency surgery or
Elective
Back ground
1. The prevalence: >55 years is 10%–25%
2. 70%–80% of affected individuals are asymptomatic
3. Pt’s with PVD alone have the same relative risk of death
from cardiovascular causes as those CAD or CVD
4. PVD pt’s = 4X more likely to die within 10 years than pt’s
without the disease.
5. The ankle–brachial pressure index (ABPI) is a simple, noninvasive bedside tool for diagnosing PAD — an ABPI <0.9 =
diagnostic for PAD
6. Patients with PAD require medical management to prevent
future coronary and cerebral vascular events.
7. Prognosis at 1 yr in patient’s with Critical Limb Ischemia (rest pain):
• Alive with two limbs — 50%
• Amputation — 25%
• Cardiovascular mortality 25%
CT Angiography
Digital Subtraction Angiography
Value of angiography
Localizes the obstruction
Visualize the arterial tree & distal
run-of
Can diagnose an embolus:
Sharp cutoff, reversed meniscus or clot
silhouette
Tắc mạch chi cấp tính
• Hồn tồn
Mức độ • Gần hồn
tồn
Vị trí
Thời
gian
• khơng
• Nghèo tuần
hồn phụ
• 6-8 giờ
30% Buttock & Hip Claudication
±Impotence – Leriche’s Syndrome
Thigh Claudication
60% Upper 2/3 Calf Claudication
Lower 1/3 Calf Claudication
Foot Claudication
Cấp tính
< 14 ngày
Cấp trên nền mạn
Triệu chứng xấu hơn
Mạn tính
> 14 ngày
< 14 ngày
Efects Of Acute Ischemia
• Reduced blood flow
– Pulseless, pallor, perishing cold
• Nerve ischemia
– Pain, paralysis, Paresthesia
• Muscle ischemia
– Rhabdomyolysis
• Ischemia reperfusion syndrome
The P ’s
• No flow in artery
– Pallor
– Pulse absent
– Perishing cold
• Nerve becomes ischemic
– Pain
– Paresthesia / anesthesia
– Paralysis
DDx of Leg Pain
1. Vascular
a)
b)
DVT (as for risk factors)
PVD (claudication)
2. Neurospinal
a)
b)
Disc Disease
Spinal Stenosis (Pseudoclaudication)
3. Neuropathic
a)
b)
Diabetes
Chronic EtOH abuse
4. Musculoskeletal
a)
b)
OA (variation with weather + time of day)
Chronic compartment syndrome
Embolus vs Thrombosis
Is it possible to differentiate between thrombosis and embolus as a cause of
acute ischaemia??
Sometime!!!!
Embolus
Thrombosis
• Previously asymptomatic, •
Previous claudication and
preexisting cause with
sudden onset of acute
sudden onset of severe
ischaemia
ischaemia (normal
contralateral pulse)
Location Common femoral disease
• Chronic: thigh and calf
claudication, palpable
the femoral pulse just
below inguinal ligament
• Acute: femoral
bifurcation is the
common site of
embolus-typical
ischaemic limb
Location-superficial femoral disease
• Chronic :a very common
place for stenosis or
occlusion where it passes
posteriorly through adductor
hiatus (Hunter’s canal)
It can produce calf
claudication, but rarely
severe in presence of
profunda femoris artery
• Acute: rare
Viable?
acute non traumatic ischemia
Irreversible
Threatened
Clear embolus
Viable
?Thrombosis
Duplex
Adequate
Inadequate
Angiogram
Treat
Amputation
Embolectomy
Thrombolyse
+/- PTA
Reconstruct
Heparin
• Xem xét chống chỉ định:
Bóc tách động mạch chủ
Đa chấn thương
Chấn thương sọ
• Bolus heparin: 5.000-10.000 UI -> Tĩnh
mạch:1.000UI (18U/kg/h)
