Acute Limb Ischemia

Santistevan, Jamie

doi:10.1016/j.emc.2017.07.006

Cited by 30 publications

(10 citation statements)

References 86 publications

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“…The added benefit of including ICP may stem from the fact that pressure changes precede clinical signs of ACS, potentially improving care team's vigilance. 24,27,28 Reasons for the lower sensitivity and specificity of clinical signs in the diagnosis of ACS have been previously discussed. 1,24 Evaluation of these signs can be challenging because they are subjective and are not unique to ACS.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Lorange

Laverdière

Corban

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both. Data Sources: A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used “lower extremity” or “leg” or “tibia” and “compartment syndrome” and “pressure” as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines. Study Selection and Extraction: Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria. Data Synthesis: The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%. Conclusions: The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…The added benefit of including ICP may stem from the fact that pressure changes precede clinical signs of ACS, potentially improving care team's vigilance. 24,27,28…”

Section: Discussionmentioning

confidence: 99%

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Lorange

Laverdière

Corban

et al. 2023

Journal of Orthopaedic Trauma

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“…The only exception to anticoagulation is if the patient is actively bleeding. 27 It is imperative that emergent vascular surgical consultation be obtained for consideration of emergent vs. urgent revascularization if the limb is salvageable. In irreversible ischemia, amputation might be the only definitive treatment.…”

Section: Discussionmentioning

confidence: 99%

Limb Ischemia in a Patient with Hyperosmolar Hyperglycemic State

Hazmi

Manning

2018

Clinical Practice and Cases in Emergency Medicine

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A 61-year-old male with a recent diagnosis of pemphigus vulgaris was brought to the emergency department for altered mental status. He had recently started taking prednisone to manage his autoimmune disease and had a progressive decline in his mental status along with decreased oral intake. Evaluation revealed hyperosmolar hyperglycemic state (HHS) and occlusive arterial thrombosis, a rare but known complication of HHS. He was resuscitated aggressively with intravenous fluids, insulin, and heparin and admitted to the intensive care unit. Emergency physicians should remain vigilant for ischemic complications in patients with HHS. Early recognition and treatment can reduce the morbidity and mortality associated with this endocrine emergency.

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“…A suspicion of acute ischemia based on history and physical examination warrants heparin administration and vascular surgery consultation [10].…”

Section: Introductionmentioning

confidence: 99%

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

Nasto

Kavrakov

2020

Open Access Maced J Med Sci

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BACKGROUND: The peripheral arterial embolism (PAE) is a sudden decrease in limb perfusion due to acute occlusion of peripheral artery which leads to ischemic tissue damage, that can threaten the limb of a patient and requires immediate revascularization. It is estimated that the incidence of acute limb emoblism in the general population is around 14/100,000 inhabitants per year. Accurate and timely diagnosis is crucial to salvage the patient’s limb and sometimes the patient’s life. In cases of complete arterial occlusion and absence of collateral perfusion, irreversible damage can occur within 4 to 6 hours. The fundamental definition for treatment of acute peripheral arterial embolism is revascularisation. Revascularisation is either performed endovascularly or by an open surgical approach. A suspicion of acute ischemia based on history and physical examination warrants heparin administration and vascular surgery consultation. Delays in the management of acute peripheral arterial ischemia due to an embolism are common and associated with poor limb - salvage outcomes. AIM: Our study aims to identify medical consultations and cardiovascular assessments undergone by patients in the period prior to being hospitalised, in order to evaluate for missed or delayed opportunities for diagnosis. METHODS: Retrospective cohort study, utilising the medical documentation and previous outpatiently or inhospital consultations. Adult patients undergone treatment due to peripheral arterial embolism were identified and analyzed. Patients were identified through the administrative hospital database using the International Classification of Diseases. Hospitalised patients with those medcodes between 1st January 2010 - 1st March 2020 were recorded. RESULTS: Following exclusion, 424 patients (mean age 68.5 ± 5.85 years) were included. 159 patients (66.8%) had visited their family doctors or other medical specialist before admission and in all of the cases was initiated therapeutic approach. The rest of the cohort 79 patients (33.2%) presented lately due to other social reasons. The group of 159 patients that admitted lately due to medical indications - diagnostic, healthcare - administrative or treatment related problems are subject of our study. The largest group including 113 (71%) patients were treated outpatientley by vascular surgeons with preventative medications.17 patients (10.6%) were directed outpatientley to orthopaedic surgeon due to suspicion of trauma.15 patients (9.4%) were treated by their family doctors with pain relief medications. The rest of the 14 patients (8.8%) were treated by neurosurgeons or neurologists due to a suspicion of cauda eniqua and other neuropathies. The majority of the patients 108 (67.9%) were free of complains at the discharge, 11.3% of the studied cohort were with minimal post-treatment complains (numbness, coldness, absent peripheral pulsations, insignificant claudicatio). Amputation rate was 14.4%, incidence of rethrombosis 8.8% and recurrent embolism frequency around 3.7%. Death was registered in 21 cases (13.2%). CONCLUSION: The consequences of acute limb embolism such as prolonged hospitalization, major limb amputation, and/or death have a profound socioeconomic impact. Unrecognition of this vascular pathology and differential diagnosis difficulties are possibly leading factors for delayed or missed treatment.

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Acute Limb Ischemia

Cited by 30 publications

References 86 publications

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

Limb Ischemia in a Patient with Hyperosmolar Hyperglycemic State

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

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