Acute limb ischaemia

{Paul Michael Clayton}
Classification and external resources
Vasuclar ischaemia of the toes with characteristic cyanosis.
ICD-9	459.9
DiseasesDB	7480

Acute limb ischaemia occurs when there is a lack of blood flow to a limb. It is usually due to either an embolism or thrombosis of an artery in those with underlying peripheral vascular disease.^[1] It is estimated to occur at a rate of 14 per 100,000 per year in the United States.^[1] It is a highly treatable condition with proper surgical care.^[2]

Critical limb ischemia (CLI), an advanced stage of peripheral arterial disease (PAD), is defined by the presence of ischemic rest pain, non-healing ulcers or gangrene for more than two weeks along with an objective evidence of ischemia 1, 2, 3. The objective evidence includes ankle-brachial index (ABI, <0.5), toe systolic pressure (<30mmHg), or ankle systolic pressure (<50mmHg) 1, 2, 3. The prevalence of PAD based on objective testing ranges from 3% to 10% in general population 1. CLI occurs in 1-2% of PAD patients who are over 50 years 1. CLI has a grave prognosis with a one-year mortality rate of 20% and a one-year amputation rate of 25% after the initial diagnosis 2. Within six months of initial diagnosis, 40% of the patients with unreconstructable disease require a major amputation 2. A major amputation is one in which a prosthesis is required to allow standing and walking; for example Syme’s amputations, and all of the amputations above the ankle 3.]^[3]

References

1. ^ ^{a b} Dormandy J, Heeck L, Vig S (June 1999). "Acute limb ischemia". Semin Vasc Surg 12 (2): 148–53. PMID 10777242. 
2. ^ O'Connell JB, Quiñones-Baldrich WJ (March 2009). "Proper evaluation and management of acute embolic versus thrombotic limb ischemia". Semin Vasc Surg 22 (1): 10–6. doi:10.1053/j.semvascsurg.2008.12.004. PMID 19298930. 
3. ^ [http://www.jpmsonline.com/jpms-vol1-issue3-pages83-84-se.html Infrapopliteal Angioplasty versus Bypass for Critical Limb Ischemia