1535_Phair.pdf

1、Acute Limb IschemiaJohn P Phair,MD Associate Professor of SurgeryMount Sinai QueensIcahn School of Medicine at Mount SinaiMount Sinai Health SystemALI Classification,Data Review and Algorithm to TreatDisclosures noneAcute Limb Ischemia Inter-Society Consensus for Management of PAD(TASC II)Definition

2、 Sudden decrease in limb perfusion causing potential threat to viability in patients who present 6-8 hours neuro/motor deficit Dysfunction/limb loss Should compliment PE by directing therapy Angiography CTA Duplex Ultrasound MRARevascularization Goals Rapid restoration of arterial patency&blood flow

3、 Limb preservation Avoidance of complications1970sHeparin or Amputation1980 Thrombo-embolectomy and bypass1990s Thrombolysis2000s Percutaneous Mechanical ThrombectomySurgical Thromboembolectomy Great option for embolus wo distal thrombosis Cardiac emboli have chronicity Rapid restoration of flow Can

4、 still use imaging on-table Over the wire embolectomy balloons to guideEmbolectomySurgical Adjuncts Endarterectomy,Patch angioplasty Bypass Intraoperative thrombolytic administration 2-10 mg tPA Angioplasty+/-stenting of culprit lesions Completion AngiographyPathophysiology Ischemia/reperfusion Toxi

5、c byproducts in ischemic tissue bed Free radicals/Protein leak/Edema Pressure impedes venous outflow Eventually impedes arterial inflow(LAST)Leads to compartment syndrome Systemic effects,hypotension,hyperKSurgical Adjuncts Fasciotomy 6hrs ischemia Or clinical evidence of compartment syndrome Perman

6、ent nerve injury,foot drop otherwiseSerial examination?compartment pressuresCompartment Syndrome Increased compartment pressure on exam Tightness on palpation Loss of sensation to light touch 1stweb space Deep peroneal nerve Pain on passive stretch Pain out of proportion to examSpecial Situations TR