Current Options in the Diagnosis and Management of Acute Limb Ischemia

Karthikeshwar Kasirajan, MD, Kenneth Ouriel, MD

Disclosures

Prog Cardiovasc Nurs. 2002;17(1) 

In This Article

Immediate Considerations

In 1978, Blaisdell et al.[4] first introduced the concept of early heparinization to prevent proximal and distal propagation of thrombus, in combination with de-layed intervention. Today, early heparinization remains one of the mainstays in the treatment of ALI. For reasons that are unclear, immediate full-dose heparinization can result in symptomatic improvement in some patients, either from the anticoagulation effects of heparin or volume expansion. Most importantly, immediate and adequate anticoagulation prevents proximal and/or distal thrombus propagation and preserves the microcirculation.

The severity of the ischemia, according to the classification presented above, will dictate the extent of diagnostic tests performed for systemic risk factor assessment. Routine blood studies and coagulation tests should be performed before heparin is administered. Correction of underlying electrolyte imbalances and systemic anticoagulation should proceed concomitantly with the other investigations. A plain chest x-ray and electrocardiogram should be obtained from every patient. In patients with suspected embolism, an echocardiogram should be obtained as soon as time allows. Despite the desirability of a complete work-up, the treatment of an ischemic limb must take priority over more complex and time-consuming investigations.

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