Management of Acute Limb Ischaemia

Описание: European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

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Explore Acute Limb Ischemia (ALI), a critical vascular emergency threatening limb and life. Based on comprehensive ESVS guidelines, ALI is a sudden drop in arterial blood flow with symptoms less than 2 weeks. Diagnosis involves clinical signs (6 Ps), ABI, and the Rutherford classification (Grades 1, 2A, 2B, 3) to assess severity. Grade 2B indicates immediate threat requiring urgent revascularization. Imaging like CTA or DSA is used for treatment planning, prioritizing speed over delay. Initial management includes urgent heparinization and oxygen. Treatment options span open surgery (embolectomy, bypass) and endovascular procedures (catheter-directed thrombolysis, aspiration). Treatment is ideally in specialist centres offering full capabilities. Trials comparing surgery and thrombolysis show similar limb salvage but distinct complication profiles; contemporary data is evolving. Reperfusion injury and compartment syndrome (CS) are major complications. CS diagnosis is clinical; urgent fasciotomy is recommended for established CS. Specific scenarios like popliteal aneurysm, acute aortic occlusion, upper limb ALI, and ALI in children have tailored approaches based on evidence and expertise. Post-treatment, follow-up involves managing underlying causes (AF, thrombosis), risk factors (smoking), and potential complications with tailored antithrombotic/antiplatelet therapy and monitoring. Significant knowledge gaps highlight the need for ongoing research and quality improvement initiatives. This deep dive unpacks crucial details for specialist clinicians.

This summary provides a concise overview of the key aspects of ALI management discussed in the source. A useful next step would be to examine the recommended treatment pathways for different Rutherford classes using the provided algorithm (Figure 11), which visually integrates diagnosis and treatment decisions.