SAQ 348 – Vascular – acute lower limb ischaemia
Model Answer
Vascular – acute lower limb ischaemia.
a. Causes
- Thrombotic, for example atherosclerotic plaque thrombosis.
- Embolic, for example atrial fibrillation, cardiac failure, or aneurysm source.
- Other vascular causes such as dissection.
b. SVS classification
| Category | Key bedside features |
|---|---|
| I viable | Not immediately threatened; intact capillary return, no sensory loss or paralysis, arterial and venous Doppler audible. |
| IIa threatened | Salvageable if promptly treated; capillary return intact/slow, no paralysis, partial sensory loss, arterial Doppler inaudible but venous audible. |
| IIb threatened | Salvageable only with immediate treatment; capillary return slow/absent, partial paralysis, partial/complete sensory loss, arterial Doppler inaudible but venous audible. |
| III irreversible | Primary amputation; absent staining/capillary return, complete paralysis with tense compartments, complete sensory loss, arterial and venous Doppler inaudible. |
c. Medications
- Fentanyl IV in aliquots titrated to pain.
- Heparin IV bolus then infusion, titrated to aPTT target according to local protocol.
d. Interventions
- Catheter-directed thrombolysis.
- Embolectomy.
- Bypass surgery.
Comments are closed for this SAQ.