Acute arterial ischemia

Clinical Features

6 Ps

• Pain - Claudication or pain with leg elevation; typically earliest sign
• Paraesthesia - May be associated with weakness; preservation of light touch is good guide to viability
• Pallor
• Paralysis
• Pulselessness - May be accompanied by skin changes; late finding
• Poikilothermia - Limb is cool to touch when compared to other side; late finding

Differential Diagnosis

• Peripheral artery disease
• Vascular injury

Foot diagnoses

Acute

• Foot and toe fractures
• Subtalar dislocation
• Metatarsophalangeal joint sprain (turf toe)
• Acute arterial ischemia
• Calcaneal bursitis

Subacute/Chronic

• Diabetic foot infection
• Peripheral artery disease
• Plantar fasciitis
• Trench foot
• Ingrown toenail
• Paronychia
• Tinea pedis
• Morton's neuroma
• Diabetic neuropathy

Management

1. Unfractionated heparin
   • 80 units/kg bolus; then infuse 18units/kg/hr
2. ASA
3. Dependent positioning
4. Pain control
5. Fluid resuscitation and treatment of heart failure as needed to improve limb perfusion
6. Vascular surgery consultation (clot retrieval, balloon angioplasty, intraarterial tPA, stenting, bypass)

Disposition

• Acute limb ischemia requires inpatient management

See Also

• Peripheral artery disease
• Vascular injury