[Acute limb ischemia from the general surgeon's point of view. How much knowledge of vascular surgery is necessary?].
The diagnosis of acute peripheral ischemia can be obtained based on clinical presentation, inspection, and palpation of the affected extremity. Unfractionated heparin as a single shot is immediately given followed by continuous infusion when diagnosis is clinically evident and contraindications are excluded. Thromboembolectomy using a Fogarty catheter is immediately performed in patients with evidence of arterial embolization and signs of advanced ischemia (TASC IIb/III) followed by intraoperative angiography. Patients with evidence of arterial thrombosis require urgent angiography followed by thrombectomy and probably subsequent endovascular or surgical interventions and vascular reconstruction. For patients with moderate ischemia (TASC IIa), initial diagnostic angiography is recommended followed by primary thrombectomy with subsequent intraoperative angiography and immediate endovascular or operative treatment of remaining vascular problems. As an alternative therapeutic option initial catheter-guided local thrombolysis can be performed in selected patients with the intention of subsequent limb revascularization or unmasking relevant vessel alterations leading to specific endovascular or surgically performed vascular reconstruction. Possible development of muscle ischemia because of increased compartment pressure should be considered and fasciotomy performed when indicated. Primary amputation of the severely ischemic limb after initial thrombectomy might be recommended in patients with life-threatening organ failure related to muscle necrosis.
Kopp
R
R
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Universität München, rkopp@gch.med.uni-muenchen.de
Weidenhagen
R
R
Hornung
H
H
Jauch
K W
KW
Lauterjung
L
L
D000208:Acute Disease; D000465:Algorithms; D000671:Amputation, Surgical; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D017128:Embolectomy; D005121:Extremities / Q000098:blood supply* / Q000601:surgery; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007511:Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D009132:Muscles / Q000098:blood supply / Q000473:pathology; D009336:Necrosis; D018579:Patient Selection; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000601:surgery*; D013997:Time Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin