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We present a case of 52 years old man with past medical history of IHD (2 vessel disease and stented 6 times) and dilated cardiomyopathy presented to us with Acute Limb Ischemia.
A 52 years old man with medical history of IHD and dilated cardiomyopathy presented to us with acute onset of bilateral lower limb pain subsequently numbness. The initial vital signs included BP=124/75, PR= 71/min, RR=18/min, SPO2 =99 % under room air and temperature of 37 degree celcious. The cardiopulmonary and abdominal examination was were unremarkable. On the extremity examination, both limbs appeared dusky, cold clammy on to touch,
numbness reduced sensation over bilateral lower limb, poor capillary refill time crt less than 4 seconds, and SPO2 ranging 70-75% all toes. On vascular examination, femoral, dorsalis pedis and popliteal arteries were DPA and PTA not palapble, popliteal and femoral pulsation absent as well as and were confirmed with by doppler. Bedside ultrasound shows 2point compression test test shows compressible but with absence of popliteal artery pulsation. On neurologic examination, The power of both lower limbs were 2/5 over the bilateral lower limb, with intact sensation was still intact with subjective complaint of numbness and tingling on his bilateral lower limb. Working diagnosis of Acute Limb Ischemia of bilateral lower limb was made.Emergent phone referral was made with to a vascular surgeon and an interventional radiologist were initiated. A computed tomography angiogram (CTA) of the abdomen and lower limb was performed and demonstrated showed an aorta-iliac occlusive disease involving the infrarenal abdominal aorta.
Acute limb ischemia in high risk patients are common, however involving bilateral lower limb is a rare condition. In our case, prompt action was taken right after clinical diagnosis as patient has already presented with cold clammy feets and absents of DPA/PTA arterial pulsation.Immediate CTA was done and was noted patient to have occusion high up at common iliac artery. Early referral to vascular surgeon and interventional radiologist are crucial to establish diagnosis and early intervention to salvage affected limb.However in this case, Patient was treated conservatively as patient having poor cardiac function.
Acute Limb ischemia is common in high risk patients. However it is rare to involve both lower limbs. It is wise to consider a higher level of occlusion in patients presented with such symptoms despite working on differential diagnosis such as hypokaleamia periodic paralysis or Guillain-barrsyndrome. Early diagnosis and intervention might safe the affected limb.
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