Acute Arterial Thrombosis


What is acute limb ischemia?

  • Ischemia means a reduction in blood supply to a particular organ. Blood supply to the limb is reduced in limb ischemia.
  • Acute implies sudden onset (hours to days), in contrast to chronic ischemia (months to years).
  • Acute limb ischemia is a medical emergency threatening the limb viability.
  • It is commonly seen in diabetics and smokers.
Chronic Limb Ischemia leg
Chronic Limb Ischemia leg

What are the causes of acute limb ischemia?

  • Clots in the heart
  • Patient with an abnormal heartbeat rhythm
  • Tobacco use
  • Diabetes
  • High cholesterol
  • A genetic factor leading to the heightened coagulation system
  • The complication of a surgical procedure
  • Injury to the limb blood vessels

How does acute limb ischemia present?

  • Sudden pain in the limb
  • Numbness and tingling sensation
  • Cold limb
  • Limb becoming colourless
  • Partial or complete inability to move the limb

What are the complications of acute limb ischemia?

  • Loss of limb due to irreversible ischemia.
  • Infection
  • Permanent nerve damage: sensory loss, muscle weakness, paralysis.
  • Stroke
  • Death

How can we diagnose acute limb ischemia?

  • Clinical examination
  • Ultrasound Doppler examination
  • CT angiogram
Acute limb ischemia
Acute limb ischemia

What are the treatment options for acute limb ischemia?

  • Medicines: Thrombolytic agent (Blood clot-dissolving medicines).The preferred treatment for mild to moderate, severe cases.
  • Embolectomy: Physical removal of a blood clot.

This can be achieved by:

a) Surgical embolectomy
b) Non-surgical embolectomy

  • Hybrid approach: Involving medical therapy with thrombolytic medicines that soften the blood clot followed by non-surgical removal of the thrombus is a modern approach. In this procedure, a plastic tube (catheter) is inserted into the blood clot and dripped with the medicine over 12 to 24 hours. This will soften the clots making it amenable for removal by extraction catheter.

What are the various surgical procedures for treating acute limb ischemia?

Surgical embolectomy Non-surgical embolectomy
Opening of the occluded artery and pulling off the blood clot. Removal of the blood clot by fragmenting it using suction or laser or ultrasound energy.

Advantages:

  • Time tested strategy
  • severe limb ischemia
  • Large-sized blood vessels
  • Clots in the proximal to medium blood vessels
  • Severe acute limb ischemia involving large blood vessels best managed
  • High success rate

Advantages:

  • Novel strategy
  • Moderate to less severe limb ischemia
  • medium-sized to small-sized blood vessels
  • Clots in the medium to distal blood vessels
  • A hybrid approach is possible
  • minimally invasive procedure
  • Short hospital stay
  • No risk of infection
  • Less risk of cardiac complications

Limitations:

  • Not useful for small arteries
  • Cannot be combined with medical therapy using a thrombolytic agent
  • Invasive procedure
  • Prolonged hospital stay
  • Risk of infection
  • Increased risk of cardiac events: Heart failure, Heart attack & consequent death
  • A hybrid approach is not possible

Limitations:

  • Not useful for large arteries
  • Cannot be used for severe ischemia involving large arteries and late cases

What is the uniqueness of treatment for acute limb ischemia by Dr C Raghu?

Acute limb ischemia is managed by using a hybrid strategy at Dr Raghu’s Cath lab. Combing an approach of catheter-directed thrombolysis followed by non-surgical embolectomy using the penumbra technology is a routine procedure at our centre. Being one of the early adopters of penumbra technology, we are well versed in the nuances and experts in delivering results. Dr Raghu has delivered many lectures at various national and international fora and has been training many doctors to adapt to this new technology.



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WE CARE, WE CAN





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Copyright © 2019, Dr C Raghu. All rights reserved.
Designed & Developed by R R Deepak Kambhampati.



Copyright © 2019, Dr C Raghu. All rights reserved.
Designed & Developed by R R Deepak Kambhampati.