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Volume 5

Journal of Current Research: Cardiology

Heart Congress 2018

November 21-22, 2018

Global Heart Congress

November 21-22, 2018 Osaka, Japan

Acute limb ischemia: A case report

Hsiu Yu Lai and Chon Seng Hong

Chi-Mei Medical Center, Taiwan

Introduction:

Acute Limb Ischemia (ALI) is a sudden decrease in limb perfusion that may threaten limb viability. The most common

cause is acute arterial total or near-total occlusion. Mortality and morbidity rate were high even after surgical or endovascular

intervention. Early recognition and revascularization are essential. A case of ALI is presented to illustrate the diagnostic and

therapeutic approach.

Case Report:

A 54-year-old man had history of ascending colon adenocarcinoma status post right hemicolectomy, sick sinus

syndrome and complete atrioventricular block status post permanent pacemaker implantation, hypertension, type 2 diabetes mellitus

and coronary artery disease. He presented with acute onset of numbness, pain and weakness of the right leg. Vital sign in emergency

department revealed blood pressure 217/88 mmHg, body temperature 36.5 ºCelsius degree and heart rate 91/min. Physical

examination revealed weak pulsation of right dorsal pedis artery and swelling and erythema of the right leg. Electrocardiography

showed atrial fibrillation and pacemaker ventricular pacing rhythm. Laboratory data revealed leukocytosis and hyperglycemia.

Computed tomography of the right lower extremity demonstrated an acute thrombosis with total occlusion from right Common

Femoral Artery (CFA) to Superficial Femoral Artery (SFA).The patient underwent endovascular therapy with balloon angioplasty

and thrombus fragmentation. The flow of SFA was restored after angioplasty but distal embolization of thrombus was noted to

popliteal artery. Consequently, a multi-hole infusion catheter was placed over popliteal artery. Intra-arterial infusion with Urokinase

1,000,000 units for 24 hours and Enoxaparin were administered. His right lower limb became warm during therapy and his symptoms

improved. Angiography was repeated on the next day. Flow of popliteal artery was restored. Mild reperfusion tissue swelling of the

right leg was observed. Finally, the patient was discharged with non-vitamin K anti-coagulant Rivaroxaban.

Conclusion:

ALI is a critical condition with high mortality and morbidity rate. Early recognition and early revascularization are

essential. Endovascular treatment is one minimally invasive procedure with effect and quick response.

Discussion:

ALI is related to high possibility of limb amputation, severe complication such as reperfusion injury and mortality. It is

essential to achieve early recognition and diagnosis. Revascularization in viable case as soon as possible plays the major role in limb

rescue and complication prevention. Surgical intervention and endovascular treatment are effective choices with quick response.

Available treatment must be chosen rapidly in this emergent disease. In our case, endovascular therapy was decided. Blood flow of

the acute ischemic limb was restored effectively with the minimally invasive procedure.

Curr Res Cardiol 2018, Volume 5

DOI: 10.4172/2368-0512-C1-003