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Pathology - Acute lower limb ischemia
Definition
A quick and abrupt interruption of the artery flow to the lower leg.
Epidemiology
• Incidence documented at 14 per 100,000 individuals annually.
Aetiology
• 60% attributable to acute thrombosis in a vessel with pre-existing atherosclerosis. • 30% resulting from a thromboembolus originating from a distant region, typically the heart. Common cardiac connections include atrial fibrillation, acute myocardial infarction, and ventricular aneurysm. Typical locations of impaction include the popliteal artery, common femoral artery, and aortic bifurcation. Less frequent causes encompass aortic dissection, trauma, and iatrogenic injury. The incidence of iatrogenic injury is increasing due to the rising use of endovascular operations.
Pathogenesis
• Abrupt obstruction of the arterial supply to the leg results in ischaemia.
• In the absence of intervention, irreparable tissue damage transpires within 6 hours. Extensive muscular necrosis results in hyperkalemia, acidosis, abrupt renal failure, and cardiac arrest.
Presentation • Abrupt emergence of pain and sensory loss in the extremity. • Upon examination, the limb exhibits pallor and coolness, accompanied by diminished or absent pulses. Prognosis: Limb loss occurs in 40% of cases. • Mortality in 20% of cases
Definition
A quick and abrupt interruption of the artery flow to the lower leg.
Epidemiology
• Incidence documented at 14 per 100,000 individuals annually.
Aetiology
• 60% attributable to acute thrombosis in a vessel with pre-existing atherosclerosis. • 30% resulting from a thromboembolus originating from a distant region, typically the heart. Common cardiac connections include atrial fibrillation, acute myocardial infarction, and ventricular aneurysm. Typical locations of impaction include the popliteal artery, common femoral artery, and aortic bifurcation. Less frequent causes encompass aortic dissection, trauma, and iatrogenic injury. The incidence of iatrogenic injury is increasing due to the rising use of endovascular operations.
Pathogenesis
• Abrupt obstruction of the arterial supply to the leg results in ischaemia.
• In the absence of intervention, irreparable tissue damage transpires within 6 hours. Extensive muscular necrosis results in hyperkalemia, acidosis, abrupt renal failure, and cardiac arrest.
Presentation • Abrupt emergence of pain and sensory loss in the extremity. • Upon examination, the limb exhibits pallor and coolness, accompanied by diminished or absent pulses. Prognosis: Limb loss occurs in 40% of cases. • Mortality in 20% of cases
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