Reviewers of multimedial algorithms Petr Kysela, MD, MSc, PhD

Petr Kysela, MD, MSc, PhD

Senior Consultant, Department of Surgery, University Hospital Brno, Brno, Czech Republic

Review of interactive algorithm Acute lower limb ischemy

The algorithm Acute lower limb ischaemia is really distinctive. This disease is really frequent and the incidence is about 14-15/ 100 000 inhabitants. Muscular  toleration of  ischaemia is appoximately 3 hours  and that is why we have to think about  this diagnosis and start to solve it during the transpost  into the hospital as we can see in this algorithm. In practice we can see 2 most frequent mistakes. The first one is that every patient with sudden pain of the lower limb is transported to the specialized vascular surgery as an acute limb ischaemia without an examination of the pulsation. Peripheral pulsation exclude an acute ischaemia, but chronical peripheral arterial disease is possible.  Good thing is that there is no delay, because acute lower limb ischaemia requires the fastest diagnosis and treatment of all of the possible causes of a limb pain. However the examination on the vascular surgery is uselessly urgent. The second mistake is diagnosing vein thrombosis and the patient comes with the vein and not the arterial examination. In this algorithm the case is really practical. This algorithm describes how it should be but not real practice. The worth thing of this algorithm is that it shows the treatment of acute limb ischaemia means only the beginning of the patient's care- we have to do next examinations to find out the cause of the ischaemia, controls and set up the efficient therapy (atrial fibrilation or other dysrrhytmia, atherosclerosis , antioedematous therapy if there is an indication of fasciothomy).

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