Acute Limb Ischemia: An Update on Diagnosis and Management

Olinic, Dan-Mircea; Stanek, Agata; Tătaru, Dan-Alexandru; Homorodean, Călin; Olinic, Maria

doi:10.3390/jcm8081215

Cited by 113 publications

(118 citation statements)

References 53 publications

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“…Non-invasive vascular assessment such as Duplex ultrasound (DUS) is the first-line imaging modality in any form of acute limb ischemia (ALI) due to its diagnostic accuracy, wide availability, low cost, rapidity, and non-invasiveness. DUS can accurately determine the presence of an aneurysm and the anatomic location and degree of thromboembolic obstruction, hence should be performed in all patients [11]. Neither aneurysm nor thromboembolic obstruction were apparent on DUS of the arteries proximal to the ischemic digits, contralateral arteries, and the venous system in our patient at the time of presentation.…”

Section: Resultsmentioning

confidence: 69%

Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report

et al. 2020

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Background: Left atrial septal pouches (LASPs) are a relatively newly described but common anatomical cardiac variant thought to be associated with atrial fibrillation (AF) and cardio-embolic stroke. Blue toe syndrome (BTS) describes ischemic changes in the toes due to microembolisation of the digital arteries. Establishing the etiology of BTS is vital so that the underlying cause can be treated. Here we describe the first case of BTS arising due to emboli from LASP thrombus arising on a background of new-onset AF. Case presentation: A 65-year-old man presented with a two-day history of progressive painful swelling and bluishpurple discoloration of the second and fourth toes of his left foot and new-onset AF. Tests for hypercoagulability disorders were negative. Duplex ultrasound and CT angiography excluded deep venous thrombosis and an absence of embolus, thrombus, or occlusion in the arterial tree in the lower extremities bilaterally, so BTS was diagnosed. While transthoracic echocardiography and chest CT initially showed no cardiac abnormalities or mural thrombus, subsequent transesophageal echocardiography revealed a LASP with an associated pedunculated thrombus. The affected toes were amputated due to wet gangrene, but the patient recovered well with thrombus resolution after anticoagulation. Conclusion: The presence of a LASP in the absence of any other identifiable cause of BTS should trigger careful investigation of the interatrial septum, preferably using a multimodality imaging approach. The possibility that LASPs may not merely be an innocent bystander but a causative mechanism for peripheral ischemia must be considered.

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Section: Resultsmentioning

confidence: 69%

Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report

et al. 2020

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“…In my opinion, CWD results should always be verified with duplex ultrasound. The high clinical utility of duplex ultrasound in acutely ischemic limb was previously confirmed [16,17].…”

Section: Overallmentioning

confidence: 83%

Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice

Łukasiewicz

2020

JCM

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The role of endovascular procedures in the treatment of acute lower limb ischemia (ALI) is expanding. For treatment, the choice between surgical or endovascular is still debated. The aim of this study was to identify factors that determine the selection of treatment. This study included 307 ALI patients (209 with thrombosis). Patient details, factors affecting the procedure choice, and outcomes were analyzed. The majority of patients were operated on (52.4%). Surgery was more frequent in embolic patients with embolus (odds ratio (OR) 33.85; 95% confidence interval (CI) 6.22–184.19, p < 0.0001), severe ischemia (OR 1.79; 95% CI 1.2–2.66, p = 0.0041), and active cancer (OR 4.99; 95% CI 1.26–19.72, p = 0.02). Tibial arteries involvement was negatively related to surgery (OR 0.25; 95% CI 0.06–0.95, p = 0.04). The complications and amputation rates were comparable. Reinterventions were more common in the endovascular group (19 (20.2%) vs. 17 (8.9%), p = 0.007). The six-month mortality was higher in the operated patients (12.6% vs. 3.2%, respectively, p = 0.001). The determinants of the treatment path are ischemia severity, concurrent cancer, embolus, and peripheral lesion location. Modification of the Rutherford acute lower limb ischemia classification is required to improve the decision-making in patients with profound ischemia.

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“…Therefore, all patients should be monitored for fluid-electrolyte balance, complete blood count, coagulation parameters, and renal, cardiac, and respiratory system. [19] In addition, patients with critical limb ischemia should be evaluated to identify the extent of local venous acidosis ischemia-reperfusion injury. [19] In particular, renal functions should be closely monitored in elderly patients and those with renal impairment before and after revascularization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of embolectomy outcomes for acute lower limb ischemia between patients aged ≥80 years and <80 years

Kubat¹

2020

Turk J Vasc Surg

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Objectives: This study aims to compare embolectomy results for acute lower limb ischemia (ALLI) between patients aged ≥80 years and <80 years. Patients and methods: A total of 65 patients (39 males, 26 females; mean age, 70.2±17.9 years; range, 20 to 94 years) who were diagnosed with ALLI and underwent urgent thromboembolectomy in our hospital between December 2016 and August 2018 were retrospectively analyzed. The patients were divided into two groups according to their age as ≥80 years (Group 1) and <80 years (Group 2). Data including baseline demographic and clinical characteristics and postoperative data were recorded. Results: There was a male predominance in Group 2, while the majority of patients were females in Group 1. Of the patients, 29 (44.6%) were operated from the right lower limb, 32 (49.2%) from the left lower limb, and four (6.2%) bilaterally. There was no significant difference in the rate of postoperative hematoma, wound infection, compartment syndrome, acute renal insufficiency, amputation, and early mortality between the groups. However, the rate of amputation was statistically significantly higher in Group 2 with late presentation, than Group 1. Conclusion: Our study results show similar results of urgent surgical thromboembolectomy between over and under 80-year-old patients with ALLI. We believe that the age of the patient should not be an exclusion criterion for embolectomy due to ALLI.

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Acute Limb Ischemia: An Update on Diagnosis and Management

Cited by 113 publications

References 53 publications

Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report

Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report

Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice

Comparison of embolectomy outcomes for acute lower limb ischemia between patients aged ≥80 years and <80 years

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