lower and upper extremity intervention

LOWER AND UPPER EXTREMITY INTERVENTION

Acute limb ischaemia, deep vein thrombosis and stenosis are conditions that affect the lower and upper extremity.

Acute limb ischaemia is the immediate decrease in the flow of blood to a limb which affects its viability. When very little blood moves to the extremities, such as the hands and feet, skin ulcers form. Acute limb ischaemia requires urgent medical intervention to prevent fatal tissue necrosis.

Causes

Acute limb ischaemia occurs as a result of embolism, thrombosis or trauma. Peripheral arterial disease, which occurs when the lining of the artery starts to thicken due to the build-up of fat, is one of the primary causes of critical limb ischaemia.

A family history of vascular disease, diabetes, high cholesterol, atrial fibrillation and hypertension increase the risk of acute limb ischaemia.

Symptoms

Pain is one of the symptoms of acute limb ischaemia. This type of discomfort worsens at night when the leg is at rest.
Other symptoms include:

  • Numbness in the leg especially when it's at rest
  • Pale skin
  • Cold limb or foot
  • Pain and paresthesia
  • Foot sores that don't heal
  • Gangrene

Diagnosis

Dr Botha and Dr Shone conduct a peripheral vascular exam to check for signs of acute limb ischaemia. Clinical signs of acute limb ischaemia vary, but noticeable symptoms include a marble, white appearance of the skin and cold, blue limbs. Less apparent signs that occur when the condition advances include paralysis, muscle fatigue and tissue necrosis.

Bedside examinations include:

  • Duplex Ultrasound: A duplex ultrasound checks for pulses in the affected extremities.
  • Electrocardiogram (ECG): An ECG confirms atrial fibrillation that occurs when the heart works irregularly and beats too fast because of poor blood circulation.
    A magnetic resonance angiography is an imaging test that serves as a guide for revascularisation of the extremities. However, this option is only viable when delayed treatment doesn't threaten the health of the limb.

Treatment

Anticoagulation therapy serves as the first stage of treatment when symptoms of acute limb ischaemia are mild.

But in most cases, surgical intervention is a priority to prevent tissue death. Endovascular treatments involve the use of surgical balloons, stents and catheters to open up blockages and remove plaque.

Additional surgical procedures to treat acute limb ischaemia include:

  • Catheter-guided Thrombolysis: Through the use of x-ray imaging, the vascular surgeon guides a catheter near the blood clot and injects medication to dissolve it completely. Thrombolysis aims to improve blood circulation and prevent embolism.
  • Thrombectomy: The vascular surgeons guide a catheter to the blood clot and remove it entirely.
  • Bypass Surgery: Dr Botha and Dr Shone perform bypass surgery to redirect blood flow around the blockage. Both vascular surgeons use a graft from synthetic material or from the patient's vein to reroute the flow of blood.

"A sound knowledge of pathology is the only safe guide for the hands of a Surgeon, no matter how skilled those hands may be. Indeed, the more skillful they are, the more dangerous they may become without this lantern to light the way. Unless he builds on that solid foundation, the Surgeon may be no better than a hewer of flesh and a drawer of blood"

- Boyd