This depends upon the underlying cause of the ischaemia. If an embolus is responsible an embolectomy may be performed whereas emergency reconstructive surgery, usually a femoro-popliteal or a femoro-tibial bypass, is indicated in thrombotic occlusion.
Distinguishing the two aetiologic agents is difficult, and requires a careful history and examination.
Blood should be tested for predisposing blood disorders, and sent for crossmatch.
Suitable anti-coagulation therapy should be started using intravenous heparin. If an arterial embolism is suspected, this anticoagulant therapy should be continued later with oral warfarin.
Arteriography will indicate the site and nature of the obstruction, but it may take up valuable time, and in some centres is only used if there is diagnostic doubt.
Fibrinolytic agents should be considered if surgery is necessary but the patient is surgically unfit. Streptokinase may be instilled directly into a clot via an arterial catheter but should not be given systemically. Thrombolysis takes time and the clot normally dissolves within 12 to 72 hours.
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