|
Recommendations for
Diagnostic Evaluation of the Cause of ALI |
|
COR |
LOE |
Recommendations |
|
I |
C-EO |
In the patient with ALI, a
comprehensive history should be obtained to determine the cause
of thrombosis and/or embolization. |
|
N/A |
In addition to identifying a known
history of PAD, the history should focus on uncovering clinical
evidence of other conditions that can result in ALI through either
embolic or thrombotic mechanisms. These conditions include atrial
fibrillation, left ventricular thrombus, aortic dissection, trauma,
hypercoagulable state, and presence of a limb artery bypass graft.
The clinical history should identify the presence or absence of a
history of MI, symptoms and signs of left ventricular dysfunction
resulting in congestive heart failure, or possible endocarditis. The
history should evaluate for possibility of deep vein thrombosis with
intracardiac shunt (eg, patent foramen ovale or other that may
result in paradoxical arterial embolism), hypercoagulable state, and
family history of thrombosis. |
|
IIa |
C-EO |
In the patient with a history of
ALI, testing for a cardiovascular cause of thromboembolism can
be useful. |
|
N/A |
Treatment of ALI should not be delayed
for testing for the underlying cause of the limb ischemia. Delay
from symptom onset to revascularization is a major determinant of
outcome.360,361 The evaluation of a cardiovascular cause of
ALI is most useful in the patient without underlying PAD. Evaluation
for cardiovascular cause includes electrocardiogram or additional
heart rhythm monitoring to detect atrial fibrillation,
electrocardiogram to detect evidence of MI, and echocardiography to
further determine whether there is a cardiac etiology for
thromboembolism, such as valvular vegetation, left atrial or left
ventricular thrombus, or intracardiac shunt.387
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