Chronic Limb Ischaemia

Question 1

What is the pathophysiology of atherosclerotic disease?

Answer 1

Normal artery develops a fatty streak which develops into an atherosclerotic plaque. This will cause symptoms of claudication and PAD.
Plaque can rupture and lead to a thrombus which can cause an TIA.

Question 2

What are important aspects of a chronic limb ischaemia history?

Answer 2

• How far a patient can walk before getting pain,
• Whether they get rest pain,
• Other limb symptoms

Question 3

What is intermittent claudication?

Answer 3

Reproducible ischaemic muscle pain on exertion caused by inadequet blood flow

Question 4

What is critical limb ischaemia?

Answer 4

• Presence of PAD in combination with rest pain, gangrene or lower limb ulceration > 2 weeks
• Emergency

Question 5

What are the investigations for chronic limb ischaemia?

Answer 5

Bloods - Exclude diabetes
Resting and exercise ankle-brachial pressure index
Arterial duplex ultrasound
Non-invasive angiography
Chest x ray

Question 6

What is the medical management of CLI?

Answer 6

• If asymptomatic then lifestyle changes
• Symptomatic PAD - Lifestyle advice and antiplatelet (clopidogrel) and Atorvastatin 80mg.
• Cilostazol

Question 7

What are some surgical options for chronic limb ischaemia?

Answer 7

endarterectomy - Opening artery and removing atherosclerotic plaque
Bypass grafting
Endovascular procedure

Question 8

What are the results of ABPI?

Answer 8

0.9-1.2 = normal
0.8-0.9 = mild disease
0.5-0.8 = moderate disease
<0.5 = severe disease

Question 9

What are the differential diagnosis for chronic limb ischaemia?

Answer 9

• Lumbar spinal stenosis (neurological claudication)
• DVT (Pain, warmth, swelling)
• Diabetic neuropathy (also experiance burning or shooting pain, increased sensitivity to touch)