Acute Vascular Event in Leg - NMS Surgery
Terms in this set (19)
What are the 6 Ps of acute arterial occlusion?
A 65yo M presents with an acute arterial occlusion of the LLE. What is most important in terms of immediate management?
Timing between ischemic event and intervention is most important
--Earlier revascularization = more complete recovery
What is the ideal time in which an occluded limb should be revascularized?
Within 6 hours
An occluded limb should be revascularized within 6 hours. What is the pt at risk for if revascularization occurs more than 6 hours after onset?
Severely impaired limb
May require amputation
A 65yo M presents with acute arterial occlusion of LLE. What treatment is appropriate at this time?
In ER -> Administer heparin
--Prevent more clot from forming
Immediately go to OR
--For early revascularization
A 65yo M presents with acute arterial occlusion of LLE. Do you need preoperative angiography or thrombolytic therapy before going to the OR?
--You will still need revascularization anyway
--This will just delay the definitive treatment
A 65yo M presents with acute arterial occlusion of LLE and you immediately go to OR. What surgical procedure is necessary?
Balloon catheter embolectomy
Balloon catheter embolectomy is the procedure of choice for acute arterial occlusion in limbs. What therapy should continue in the post-op period?
Continue anticoagulation after the procedure
After revascularization of an occluded limb, your pt has good perfusion to the foot and toes, but inability to dorsiflex the foot and tenderness in the calf. What is the most likely cause of this?
Muscular compartment syndrome
--Occurred following ischemia-reperfusion injury
Compartment syndrome may occur after revascularization of an acutely ischemic limb. Why does this occur?
Reperfusion of the ischemic limb results in edema of the muscle
--Pressure increases since muscle is contained within the fascia
--Increased pressure decreases perfusion, causing more ischemia, worsening edema more
Following revascularization of an acutely ischemic limb, your pt develops compartment syndrome. How would you manage this pt?
DO NOT WAIT for advanced symptoms
--Motor/sensory loss, loss of pulses
What is the long term management of a pt who experienced an acute arterial occlusion in a limb?
Chronic anticoagulation therapy
--Prevent recurrent occlusion
Once stable, search for source of the embolism
Your pt recently underwent a coronary angiogram using the femoral artery approach. Now he presents with an acutely occluded limb. What caused the acutely occluded limb?
Punctures in the femoral artery can dislodge atherosclerotic plaques
--Plaques can travel and occlude vessels
Your pt recently underwent a coronary angiogram using the femoral artery approach. Now he presents with an acutely occluded limb. How would management of this pt differ from someone who spontaneously occluded an artery?
--Diagnosis is still acute arterial ischemia
--Treatment is still the same
Embolectomy to revascularize limb
Pt presents with acute arterial ischemia. He gets perioperative heparin and catheter embolectomy within 6 hours of onset. What % of limbs are salvaged?
92% of limbs are salvaged
Pt presents with acute arterial ischemia. He gets perioperative heparin and catheter embolectomy greater than 12 hours of onset. What % of limbs are salvaged?
78% of limbs are salvaged when treatment delayed >12 hrs
Pt presents with acute arterial ischemia. He gets perioperative heparin and catheter embolectomy within 6 hours of onset. What is the mortality of catheter embolectomy?
Pt presents with acute arterial ischemia. He gets perioperative heparin and catheter embolectomy. What are the common sources of arterial emboli?
What is the most common site for a peripheral artery to be occluded?
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