Acute arterial occlusion
- Usually thrombotic occlusions are class I or IIA and are treated with intra-arterial thrombolysis if symptom duration <14 days (especially if bypass graft occlusion) and if patient has significant co-morbidities/high operative risk.
- Usually embolic occlusions are class IIB or III. They usually require surgery as thrombolytics take effect too slowly.
Pain, pallor, pulselessness, paresthesias, paralysis
Venous ulcers-prox to or at ankle, especially medial malleolus
Buergers disease-hands and feet, 20 y/o men who smoke
Arterial Embolism-4-6 hours for limb salvage. Heparin (80,18)
Ulnar artery aneurysm-hypothenar hammer syndrome (using hand to bang)
Mycotic aneurysm-from endocarditis
Henoch-Schonlein purpura-palpable purpura, abd pain, arthritis
Thoracic Outlet syndrome-test c EAST (elevated arm stress test)-arms abducted at 90, elbows flexed 90. Open and close fists for 3 minutes. Numbness or limb heaviness is positive
HD catheters which get obstructed-try urokinase (5000 u)
Use venous side of fistula or graft for blood draw.
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