Acute limb ischemia: state of the art

摘要

abstract_textpAcute limb ischemia (ALI) is a danger to the life as well as the affected limb of the patient and has a high amputation and mortality rate; therefore, ALI is a vascular emergency which requires immediate revascularization. The causes of ALI are lower extremity embolisms originating from the heart, proximal arterial aneurysms, arterial thrombosis, thrombosis of a bypass graft, aortic dissection and arterial injury. The 30-day risk of major amputation is 10-30 while the 30-day mortality is 15-20. The extent of symptoms is dependent on the presence of sufficient collateral perfusion. The clinical symptoms of ALI can be classified according to the 6 Ps of Pratt and the Rutherford classification. There are two kinds of ischemia: complete ischemia with the full extent of symptoms and an incomplete form of ischemia without sensory loss and muscle weakness. Acute limb compartment syndrome and a life-threatening reperfusion syndrome may be complications of ALI. The use of computed tomography angiography (CTA) in cases with a complex history can be helpful for therapy planning. The standard procedures for diagnostics are duplex sonography and angiography. Treatment options are open surgery, endovascular therapy and a combination of both (hybrid procedure). Endovascular therapy and open surgery now have a comparable status in the treatment of ALI./p/abstract_text