Arterial embolism/thrombosis: The Daily PANCE Blueprint

Arterial embolism/thrombosis: The Daily PANCE Blueprint

A 59-year-old male with a history of hypertension, tobacco abuse, and osteoarthritis presents to the ER due to acute, severe left leg pain and numbness x 5 days. He is tachycardic upon arrival (HR 102 bpm, irregularly irregular). On exam, you notice that his left leg is cool, without palpable dorsalis pedis or posterior tibial pulses. Imaging demonstrates occlusion of the left common femoral artery. You put in an order to start IV heparin. Which of the following is the best treatment for this patient?

A. IV heparin alone
B. Limb amputation
C. Balloon catheter embolectomy
D. Bypass surgery
E. None of the above

Answer and topic summary

The answer is C. Balloon catheter embolectomy

Acute limb ischemia is an emergency. It basically occurs because the arterial blood supply to a limb is reduced. Etiologies include arterial thrombosis (e.g., PAD, stent thrombosis, vasculitis) or embolism (e.g., cardiac emboli from Afib, DVT) or trauma. Classically clinical features include the “6 Ps” – paresthesia, paralysis, poikilothermic, pulselessness, pallor, and pain. The lower limbs are more commonly impacted. The best initial test is arterial dopplers; a run-off CTA is ordered to confirm. Treatment for acute limb ischemic is IV heparin followed by revascularization (catheter-directed thrombolysis and/or percutaneous mechanical thromboembolectomy).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular DiseaseArterial embolism/thrombosis

Also covered as part of the General Surgery EOR topic lists

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