Management of acute limb ischemia: duplex assisted

Background Duplex ultrasonography (DUS) offers a fast, noninvasive tool for diagnosis and guiding treatment for acute limb ischemia (ALI). Aim To evaluate the use of DUS in the management of ALI regarding preoperative evaluation, intraoperative guidance, and postoperative follow-up. Patients and methods This prospective study was conducted on 20 patients who presented with ALI of either upper or lower limbs, Rutherford classification stage 1, 2a, 2b, with impaired renal functions or sensitivity to contrast material who cannot perform computed tomography angiography. All patients were managed according to the suitable management plan, either thromboembolectomy, thrombolytic therapy or surgical bypass with the help of DUS. Results DUS played an important role in the management of different ALI cases as there were significant changes in peak systolic velocity (PSV) across different arteries of the limb when comparing preoperative measurements to postoperative values at 1 week and 1 month follow-ups. Regarding mean PSV in outflow vessels of the lower limb postoperatively, Anterior tibial artery and posterior tibial artery show a significant increase in mean PSV in the postoperative evaluations compared with preoperative evaluations. Motor and sensory function were followed-up 1 week and 1 month postoperatively and was intact in all cases except for one case in which it was slightly impaired. Conclusions DUS has an important role in the management of cases of ALI regarding differentiation of the cause, planning for the type of incision, visualizing the Fogarty or thrombolytic catheter during intervention and even in the postoperative evaluation of the intervention.