Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb. Acute limb ischaemia is caused by embolism or thrombosis, or rarely by dissection or trauma Thrombosis is usually caused by peripheral vascular disease (atherosclerotic disease that leads to blood vessel blockage), while an embolism is usually of cardiac origin With proper surgical care, acute limb ischaemia is a highly treatable condition; however, delayed treatment (beyond 6 to 12 hours) can result in permanent disability, amputation, and/or death. In contrast to acute limb ischemia, chronic limb threatening ischemia results from peripheral artery disease that develops over time. While limbs in both acute and chronic limb ischemia may be pulseless, a chronically ischemic limb is typically warm and pink due to a well-developed collateral artery network and does not need emergency intervention to avoid limb los. Dr Simit Vora is Specialist Vascular Surgeon in Borivali.

Signs and symptoms

Acute limb ischaemia can occur in patients through all age groups. People who smoke tobacco cigarettes and have diabetes mellitus are at a higher risk of developing acute limb ischaemia. Most cases involve people with atherosclerosis problems.

Symptoms of acute limb ischaemia include:

• Pain
• Pallor (pale appearance of the limb)
• Paresthesias (abnormal sensations in the limb)
• Perishingly cold
• Pulselessness
• Paralysis

These symptoms are called "the six P's'"; they are commonly mis-attributed to compartment syndrome. One more symptom would be the development of gangrene. Immediate medical attention should be sought with any of the symptoms. In late stages, paresthesia is replaced by anesthesia (numbness) due to death of nerve cells. In some cases, gangrene can occur suddenly and spread rapidly, and should be treated within six hours of ischaemia. Dr Simit Vora is Specialist Vascular Surgeon in Borivali.

Diagnosis

In order to treat acute limb ischaemia there are a series of things that can be done to determine where the occlusion is located, the severity, and what the cause was. To find out where the occlusion is located one of the things that can be done is simply a pulse examination to see where the heart rate can be detected and where it stops being sensed. Also, there is a lower body temperature below the occlusion as well as paleness. A Doppler evaluation is used to show the extent and severity of the ischaemia by showing flow in smaller arteries. Other diagnostical tools are duplex ultrasonography, computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The CTA and MRA are used most often because the duplex ultrasonography although non-invasive is not precise in planning revascularization. CTA uses radiation and may not pick up on vessels for revascularization that are distal to the occlusion, but it is much quicker than MRA In treating acute limb ischaemia time is everything. In the worst cases, acute limb ischaemia progresses to critical limb ischaemia, and results in death or limb loss. Early detection and steps towards fixing the problem with limb-sparing techniques can salvage the limb. Compartment syndrome can occur because of acute limb ischaemia because of the biotoxins that accumulate distal to the occlusion resulting in edema. Dr Simit Vora is Specialist Vascular Surgeon in Borivali.

Causes

Most acute limb ischemia is caused by embolism, thrombosis, peripheral artery disease due to atherosclerosis, or major trauma. Rare causes include popliteal entrapment syndrome, adventitial cystic disease, phlegmasia, and thoracic outlet syndrome.

Treatment

Surgery

The primary intervention in acute limb ischaemia is emergency embolectomy using a Fogarty Catheter, providing the limb is still viable within the 4-6h timeframe Other options include a vascular bypass to route blood flow around the clot. Dr Simit Vora is Specialist Vascular Surgeon in Borivali.