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Acute limb ischemia is a condition where the blood supply to a limb is suddenly interrupted, The commonest cause for this is a blood clot (embolus) from the heart. Patients normally have no previous history of limb arterial disease but may have a history of heart disease. The symptoms of acute ischaemia depend largely on the site and size of the artery occluded. The commonest arteries affected are those of the legs. Patients usually feel sudden leg pain followed soon after by weakness or complete loss of movement and sensation. The limb becomes cold and pale. If left untreated, manifestations of systemic illness such as kidney failure, heart failure and breathing difficulty appear with an ultimately lethal effect. This condition is, therefore, not only limb threatening but is also life threatening. Acute limb ischaemia will almost always require emergency surgical or radiological intervention. Surgery usually involves exploring the affected artery and clearing the blood clot mechanically by various special catheters, and biochemically by an infusion of a clot dissolving drug. Clearing the affected artery may sometimes not be possible. In which case, an emergency bypass surgery will be needed. Following surgery, patients undergo a variety of investigations in order to discover the source of embolisation. Most patients will require long term anticoagulation with Warfarin. The risk of procedure failure and subsequently limb loss are high and very much dependent on the duration of ischaemia prior to surgery. The longer the delay, the more likely that the damage to muscles and nerves is irreversible. Many patients will require release incisions to the skin of the leg (Fasciotomies). These are designed to avoid a build up of pressure inside the various leg compartments following successful restoration of blood supply. Other causes of acute ischaemia include sudden occlusion of an arterial graft, sudden occlusion of an aneurysm of the arteries behind the knee (popliteal arteries), or traumatic injury to a major artery. |
Acute occlusion of the right popliteal artery. The right leg has become acutely ischaemic with patchy skin necrosis.
An embolus completely occluding the popliteal artery
The embolus after removal from the artery |
