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Vascular emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Acute limb ischaemia is a vascular emergency that occurs when there is a sudden occlusion of the arterial supply to a limb. It is commonly caused by either an acute thrombotic occlusion of a previously stenosed arterial segment, or an acute embolic occlusion, most frequently cardiac in origin (atrial fibrillation, MI). Other causes include trauma and aortic dissection. The incidence of acute limb ischaemia in the UK is approximately 1 in 6000 per year and carries a significant mortality rate of 15%–25%.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Sudden blockage of a major limb artery may occur as a result of thrombosis against a background of atherosclerosis, embolism or trauma. It commonly results in limb-threatening ischaemia and constitutes a vascular surgical emergency. The symptoms and signs of acute limb ischaemia have since time immemorial been taught as six ‘Ps’: pain, pallor, pulselessness, paraesthesia, paralysis and ‘perishing with cold’. Despite this, the diagnosis of acute limb ischaemia is frequently missed, or delayed until it is too late for the limb to be saved, resulting in avoidable limb loss. It is at first sight surprising that a condition with six characteristic symptoms and signs should so often be missed. The reasons for this include the following:
General surgery
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
Matthew Clark, Jevan Taylor, Steven Thrush
An examination will need to assess the viability of the limb and the urgency for intervention. Sensory and motor function should be assessed and recorded. If the diagnosis is in doubt, ABPIs can be performed. The patient’s general state should be assessed because acute limb ischaemia is often a pre-morbid episode and surgical intervention may cause unnecessary suffering.
Upper extremity necrotizing fasciitis in a Covid-19 patient
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Sriram Sankaranarayanan, Amanda F. Spielman, Anne-Sophie Lessard, Tarik Husain
In a recent review of 42 patients with COVID-19 and Acute Limb Ischaemia (ALI), Wohlauer et al. [10] found that the upper extremity was involved in 14% of the patients. Age > 60 years, hypertension, peripheral vascular disease and diabetes were found to be risk factors for the development of Acute Limb Ischaemia. Interestingly, the authors found that while ALI may be seen in patients with severe COVID-19, it is also being recognized to occur in patients with even mild to moderate COVID-19 symptoms. In their review, ALI has also been an initial presenting symptom of COVID-19 in the absence of respiratory symptoms. The patient presented in this case report developed ischaemia and gangrene in his finger insidiously. He did not recall any trauma or other inciting factors. The patient had only mild to moderate COVID-19 pulmonary symptoms. These findings are similar to the findings of Wohlauer et al. in their review.
Effects of Trans-Cinnamaldehyde on Reperfused Ischemic Skeletal Muscle and the Relationship to Laminin
Published in Journal of Investigative Surgery, 2021
Esra Pekoglu, Belgin Buyukakilli, Cagatay Han Turkseven, Ebru Balli, Gulsen Bayrak, Burak Cimen, Senay Balci
In most phytotherapy studies, it was seen that antioxidant-derived plants were used to reduce ROS formation. Therefore, the prophylactic effects of cinnamaldehyde are becoming increasingly important. 98% of the essential oils found in the structure of Cinnamon, an evergreen aromatic fragrant tree of the laurel family, are cinnamaldehyde [11]. Cinnamaldehyde is known to enhance antioxidant defense against ROS [12]. The natural product of cinnamaldehyde is trans-cinnamaldehyde (TCA) [11]. TCA has various pharmacological properties including anti-inflammatory activity [13]. In the I-R model of causing brain injury in rat, TCA has been reported to have a potential neuroprotective effect against ischemic stroke [14]. In another study, cinnamaldehyde was reported to protect the brain from ischemia injury by repressing inflammation [15]. Song et al. showed that cinnamaldehyde preserves the myocardium from I-R damage [16]. Also, in acute limb ischemia, rapid diagnosis and treatment are necessary to maintain the extremity. Animal models of I-R have been generally used to investigate the pathophysiology and the results of I-R injury, as well as cellular and gene therapies [17]. Although many treatment methods have been tried, there are few studies focused on improving the muscle function loss caused by lower extremity I-R injury. However, in recent years, prophylactic treatment studies have increased rapidly within the scope for phytotherapy. Especially TCA, which has anti-inflammatory and antioxidant effects, is emphasized. The previous studies recommended that cinnamaldehyde may be a healing candidate for ischemia injury.
Alternative Access for Mechanical Circulatory Support
Published in Structural Heart, 2020
Mir B. Basir, Marvin H. Eng, Pedro Villablanca, Mark B. Anderson, Mohammad Zaidan, Dee Dee Wang, Khaldoon Alaswad, William W. O’Neill, Mohammad Alqarqaz
Vascular access complications including perforation, dissection, and acute vessel closure can be life threatening. Acute limb ischemia due to a complication or secondary to underlying PAD, low cardiac output, or obstruction from large-bore access, is associated with decreased survival.11 Placement of distal arterial perfusion catheters has been demonstrated to prevent or reverse the effects of limb ischemia and is recommended prophylactically when using large-bore MCS.12 Given the high complication rates associated with the use of MCS, careful monitoring with neurovascular checks, near-infrared spectroscopy, and doppler signals are important tools to monitor for the early detection of limb ischemia. Similarly, continuous assessment to wean and subsequently remove MCS should be undertaken frequently to decrease the duration of use. These factors are therefore important to take into consideration when assessing the ideal access for MCS delivery.