Acute arterial embolus management

tx of acute arterial embolus

Haisook said:

In the case of a confirmed acute arterial embolus, what's the first thing to do? Give heparin or embolectomy?

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tx of AAE
As the cause of the AAE vary by age
as in young dt underlying cardiac condition (e.g M.S with A.F OR LF atrial thrombus on top of myxoma)
or in OLD pt. dt diseased atherosclerotic vessel that is complicated by overlying thrombus ........
Any of Both -->shower of emboli that lead to the condition

Though emergency tx by Embolesctomy with Fogarty (within 6 hrs) and as long as a viable limb, PREOPERATIVE preparation necessiates use of Heparin to control underlying thrombotic event that showers the emboli and prevent progression of an existing thrombus
also should include morphia --> pain control, fluids if dehydration is a risk factor , and care about cardiac condition (e.g digoxin 4 rapid A.F)
THEN Heparin to be continued postoperatively till assessing need 4 further anticoagulant regimen

tPA

cool_atomic said:

why not start with tPA (streptokinase) as a thrombolytic and then proceed to surgery if it does not help?

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tPA is a thrombolytic agent has many uses in many thrombotic events
here in context of acute ischemia it is indicated in case of acute arterial thrombosis not Acute arterial embolism..=AAE
these are2 different terms meaning
thrombus is that pathological process occuring on top of atherosclerotic a. ,on an aneurysm (dt turbulenc eof bl flow in the aneur.) ,traumatic contusion of a vessel or even may complicate hemoconc dt dehydration attack e.g old pt who had a diarrheal attack.
whie embolism ( a greek word means PLUG) is passage of a material from part of the circulatn to another to arrest in artery narrow 2 allow it 2 pass.
generally AAT RESULTS IN ISCHEMIA that is less severe than in AAE ..as in AAT there is usually a chronic state of iscemia that opened collaterals

surgery after tPA

tkourkou said:

Because probably, surgery is contraindicated after tPA use...

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in moderate acute isch dt AAT ...i read about using tPA then proceed to elective revasculariz surgery.... i
while in severe they proceed 2 emer revasc