3. Definición
La insuficiencia arterial aguda y crónica es
resultado de las alteraciones hemodinámicas
producto e la obstrucción arterial brusca o
paulatina en cualquier territorio e la
economía.
4. Acute Limb Ischemia
Is defined as sudden loss of limb perfusion and
the term is applicable up to 2 weeks after an
initiating event
5. Chronic Limb Ischemia
Is reserved for patients with objectively
proven arterial occlusive disease and
symptoms lasting for more than 2 weeks.
6. Fisiopatología
The lower extremity may be salvaged after up to 5 to
6 hours of profound ischemia.
Skin and bone are relatively resistant to the effects
of ischemia
Nervous tissue is generally the most sensitive
component of the extremity to the effects of
ischemia
Skeletal muscle plays a pivotal role in the numerous
local and systemic manifestations of extremity
ischemia-reperfusion injury.
Alteración del flujo laminar se ocasiona turbulencia y
como consecuencia lesión enotelial.
7. Síndrome de reperfusión
Daño a la membrana celular
Fallo de la bomba ATPasa
Edema intersticial debido a permeabilidad de
la membrana a iones proteínas y agua.
Radicales libres que atacan a los ácidos
grasos de la membrana fosfolipídica celular
causando daño mecánico y funcional.
10. Cuadro clínico
“Five Ps”: pain, pallor, paresthesias, paralysis,
and pulselessness, to which some add a sixth
"P"—poikilothermia or "perishing cold.
Clinical evaluation is extremely important in
determining the etiology and location of the
obstruction. One of the most important
pieces of information to obtain is whether the
patient has had prior vascular procedures or if
there is a history of LE claudication.
11. Exploración física
Hipotermia
Llenado capilar prolongado o ausente
Alteraciones sensoriales o motoras
Cambios irreversibles en músculo o piel
Patients with acute arterial embolism generally
have normal palpable pulses above the occlusion
with a complete absence below.The pulse
immediately above the occlusion may be
particularly prominent with a “water-hammer”
quality that results from limited arterial outflow.
12. Cuadro clínico de la CLI
Patients have such long-standing and severe
ischemia that irreversible ischemic injury to the
extremity (manifesting as rigor of the muscles or
frank gangrenous changes to the foot) has
occurred.
Dolor en ciertos grupos musculares producto de
la actividad que ceden al descanso.
Clauicación incapacitante
Dolor en reposo
Úlceras isquémicas
13. Diagnóstico clínico
The diagnosis of LE occlusive disease often is
made based upon a focused history and
physical examination, and confirmed by the
imaging studies. A well-performed physical
examination often reveals the site of lesions
by detecting changes in pulses, temperature,
and appearances.
14. Diagnóstico por laboratorio
y gabinete
No invasores:
- cuantificación de presiones sistólicas
segmentarias en reposo y con prueba de
esfuerzo
- Doppler y ultrasonofrafía duplex
- morfología e la onda de volumen del pulso
- La presión parcial de O2 transcutáneo
Invasores :
- arteriografía ordinaria o
- la de sustracción digital
15. Tratamiento médico
IV heparin bolus (5000-10,000 units) and
begun on a continuous infusion at 1000
units/hour.
16. Tratamiento quirurgico (ALI)
Amputación: patients have such long-
standing and severe ischemia that irreversible
ischemic injury to the extremity (manifesting
as rigor of the muscles or frank gangrenous
changes to the foot) has occurred.
Trombectomía
18. Bibliografía
Townsend: SabistonTextbook of Surgery,
18th ed.
Schwartz's Principles of Surgery, Ninth
Edition.
Patología estructural y funcional 7 ed
Tratado de cirugía general, CMCG, 2 ed