Conditions associated with distal ischemia:
(1) arterial thrombosis or other occlusion
(2) no or poor collateral circulation
(3) severe peripheral vascular disease
(4) vasospasm
Risk factors for peripheral vascular disease:
(1) smoking
(2) diabetes mellitus
(3) hyperlipidemia
Other factors contributing to limb ischemia:
(1) end-stage renal disease
(2) malignancy (which may be associated with a hypercoagulable state)
(3) activated coagulation (DIC, heparin-induced thrombocytopenia, etc.)
(4) shock and/or vasopressors
(5) previous surgery or trauma to the limb
Clinical findings:
(1) loss of distal pulse
(2) paresthesias or pain in the arterial distribution
(3) cyanosis or dusky discoloration
(4) loss of distal sensory and/or motor function
(5) loss of blood flow on Doppler flow or other imaging studies
The extent of ischemia can be categorized as for peripheral artery disease (Rutherford et al):
|
Extent of Ischemia
|
Category
|
|
viable; no immediate risk of ischemia
|
I
|
|
marginal threat with minimal sensory loss limited to the fingers
|
IIa
|
|
significant risk with motor loss and/or continuous pain at rest
|
IIb
|
|
irreversible
|
III
|
