Professional Documents
Culture Documents
Jibran Mohsin
Resident, Surgical Unit I
SIMS/Services Hospital, Lahore
J Am Coll Cardiol. 2017 Mar 21;69(11):e71-126.
Components
• PAD (Peripheral arterial disease)
• 3 categories
Categories Class Sensory loss Motor loss Capillary refill Arterial flow Venous Tissue loss
(Doppler) flow
(Doppler)
Viable (not I No No Audible Audible Minor
immediately
threatened)
Threatened II a (marginally Limited to toes if No muscle Slow-to-intact Inaudible audible Minor
(salvageable) threatened) present weakness
II b (immediately > Toes and with Mild-moderate slow-to-absent
threatened) rest pain muscle
weakness
Irreversible III Profound profound Inaudible inaudible Major tissue
(nonsalvageabl sensory loss, muscle loss
e) Anesthetic weakness or inevtible
paralysis (rigor)
Permanent nerve damage
inevitable
Clinical Presentation of ALI:
Recommendations
(Heparin (generally IV UFH) is given to all patients acutely. This can stop thrombus propagation and may provide an
anti-inflammatory effect that lessens the ischemia)
(in case of HIT and thrombosis direct thrombin inhibitor)
Revascularization for ALI: Recommendations
(Emergently vs urgent)
(Catheter-directed thrombolysis vs surgical thromboembolectomy)
RAPID RESTORATION of arterial flow with least risk to patient
Revascularization for ALI: Recommendations
(Particularly in setting of recent occlusion, thrombosis of synthetic grafts, and stent thrombosis)
Revascularization for ALI: Recommendations
(low potential of limb salvage ad risk of reperfusion syndrome and associated MOF)
*may be deferred if pain under control and no infection and meets with patients goals
Revascularization for ALI: Recommendations
• Patients with ALI should be monitored and treated (e.g., fasciotomy) for compartment syndrome
after revascularization
Indications
1. Raised intra compartment pressure (> 30 mmHg) – not always easily accessible
2. Clinical: increased pain, tense muscle, or nerve injury
3. Category IIb ischemia for whom time to revascularization is > 4 hours
Revascularization for ALI: Recommendations
• In patients with ALI due to embolism* and with a salvageable limb, surgical
thromboembolectomy can be effective
(History: MI, LV dysfunction CCF, endocarditis, DVT with intracardiac shunt ( paradoxical artrial
embolism)
Diagnostic Evaluation of the Cause of ALI:
Recommendations