HTHSCI 1DT3 Lecture Notes - Lecture 3: Acute Limb Ischaemia, Embolectomy, Cardiac Myxoma
26 Dec 2020
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Acute on chronic: worsening symptoms and signs <14d. Loss of limb unless intervention w/i/ 6hrs. A previously stenosed vessel c plaque rupture. In an acutely ischaemic limb discuss immediately c a senior as time is crucial. Abx: e. g augmentin if signs of infection. Not performed if there is complete occlusion as it introduces delay: take straight to theatre. If incomplete occlusion, pre-op angio will guide any distal bypass. Balloon inflated and catheter withdrawn, removing the embolism. Send embolism for histo (exclude atrial myxoma) Adequacy confirmed by on-table angiography: thrombolysis. E. g. local injection of tpa: other options. Id embolic source: ecg, echo, us aorta, fem and pop. Stroke: sudden neurological deficit of vascular origin lasting >24h. Tia: sudden neurological deficit of vascular origin lasting <24h (usually lasts <1h) c complete recovery. Turbulent flow shear stress @ carotid bifurcation promoting atherosclerosis and plaque formation. Plaque rupture complete occlusion or distal emboli. Less invasive: hospital stay, infection, cn injury.
