How to treat ALI

Acute limb ischemia is a surgical emergency because it can result in sudden

necrosis. Usually, there is no time to obtain an ultrasound. 

Confirmation of absent peripheral pulses on palpation can be performed with a

portable Doppler pen. But, the patient is likely to go straight to the catheterization
laboratory or the operating room.

Figure 2.  Because acute limb ischemia (ALI) can result in sudden necrosis, it is considered a surgical
emergency.

Pseudoaneurysms
Iatrogenic arterial wall trauma can occur during a procedure such as vessel
catheterization. The catheter can accidentally penetrate the arterial wall causing
blood to leak out into the surrounding tissue. This contained rupture is called a
pseudoaneurysm. 

A common iatrogenic pseudoaneurysm results from catheterization of the common

femoral artery in the groin. It usually presents as a pulsatile mass in one side of the groin.

With a pseudoaneurysm, blood flows from the artery through the puncture and forms
into a round collection of active blood flow. This blood collection is connected to the
artery by a neck (e.g., a trail of blood between the artery and the blood collection). 

The blood flow swirls within the pseudoaneurysm, creating a yin-yang color effect
on an ultrasound. The neck is characterized by to-and-fro flow, meaning that the
blood actively flows back and forth from the artery to the pseudoaneurysm. 

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