User:D214386/Acute limb ischaemia
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[edit]Causes
[edit]Most acute limb ischemia is caused by thrombosis (40% of the cases), embolism (30%), vascular graft thrombosis (20%), thrombosis by popliteal artery aneurysm (5%), and major trauma (5%) .
Risk factors include history of diabetes, coronary artery disease, tobacco use, atrial fibrillation, hypercoagulable disorders, autoimmune diseases, or diseases affecting connective tissues, such as Ehlers-Danlos syndrome.[1] In a patient with otherwise no known risk factors, atrial fibrillation with embolism should be suspected.[1]
Thrombosis
[edit]Thrombosis occurs when a blood clot forms within an artery, which can result from atherosclerosis or a hypercoagulable state.[2] This leads to an occlusion of the artery and thus ischemia. Unlike embolic causes of limb ischemia, thrombosis is progressive and develops over time.[2] In hypercoagulable states, thrombosis can occur in areas without atherosclerosis, and usually presents in patients with malignancy, hyperviscosity, or low blood flow.[2]
Embolism
[edit]Common sources of emboli leading to arterial occlusions include mural thrombi from the heart or debris from the proximal aorta. As the emboli travel through the peripheral arteries, which are more narrow, the risk of occlusion increases.[2] The arteries most commonly affected by emboli include the common femoral, common iliac, and popliteal artery bifurcations.[3]
Vascular graft thrombosis
[edit]Thromboses as a result of cardiac interventions has become increasingly common. Clots may form at the sheath or catheter tip, potentially causing embolism during sheath removal.
Aneurysm
[edit]Thromboses forming within aneurysms are most frequently seen in the popliteal artery.[4] Acute limb ischemia due to a popliteal artery aneurysm has been reported to have a 20-60% chance of limb loss and 12% mortality rate.[4]
Trauma
[edit]Acute limb ischemia may also be caused by traumatic disruption of blood flow to a limb, which may present with either hard signs or soft signs of vascular injury.[2] Hard signs include pulsatile bleeding, expanding hematoma, or absent distal pulses, and must be taken to surgery emergently. Soft signs include reduced pulses or nerve damage.[2]
References
[edit]- ^ a b Gilliland, Charles; Shah, Jay; Martin, Jonathan G.; Miller, Michael J. (2017-12). "Acute Limb Ischemia". Techniques in Vascular and Interventional Radiology. 20 (4): 274–280. doi:10.1053/j.tvir.2017.10.008. ISSN 1089-2516.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c d e f McNally, Michael M.; Univers, Junior (2018-10). "Acute Limb Ischemia". Surgical Clinics of North America. 98 (5): 1081–1096. doi:10.1016/j.suc.2018.05.002.
{{cite journal}}: Check date values in:|date=(help) - ^ Abbott, William M.; Maloney, Randolph D.; McCabe, Charles C.; Lee, Christine E.; Wirthlin, Leroy S. (1982-04). "Arterial embolism: A 44 year perspective". The American Journal of Surgery. 143 (4): 460–464. doi:10.1016/0002-9610(82)90196-9.
{{cite journal}}: Check date values in:|date=(help) - ^ a b Walker, T. Gregory (2009-06). "Acute Limb Ischemia". Techniques in Vascular and Interventional Radiology. 12 (2): 117–129. doi:10.1053/j.tvir.2009.08.005.
{{cite journal}}: Check date values in:|date=(help)