Chronic Limb Ischaemia Flashcards
Define Chronic limb ischaemia
a form of peripheral arterial disease that results in a symptomatic reduced blood supply to the limbs
CLI risk factors
smoking
diabetes mellitus
hypertension
hyperlipidaemia,
increasing age
a strong family history
obesity or physical inactivity
CLI Sx
intermitten claudication: cramping-type pain in the calf, thigh, or buttock after walking a fixed distance; relived by rest.
what is the classification of claudication called
Fontaine classification
Fontaine classification stages
Stage I Asymptomatic
Stage II Intermittent claudication
Stage III Ischaemic rest pain
Stage IV Ulceration or gangrene, or both
CLI signs
- Pallor
- Perishingly cold
- Pulselessness (reduced / abscent)
- distal cyanosis
- Aterial ulcers
chronic limb ischaemia causes
atherosclerosis
vasculitis (rare)
PAD Ix
- ABPI: ankle/Brachial SBP
- Duplex (Doppler/B-mode USS): visualises blood flow / arterial narrowing. Assess the severity and anatomical location of any occlusion.
- CT angiography (CTA) or MR angiography (MRA)
ABPI range
- Normal: 1.0 – 1.4
- PAD: < 0.9
- Severe PAD / Critical Ischaemia: < 0.5
- >1.4 → Possible calcified, non-compressible arteries (e.g., in diabetes)
what does the duplex identify in PAD
stenosis, occlusions, and plaque burden
what special test can be done for PAD
Buerger’s test: lifting legs at 45 degrees 1-2mins and then hang their legs off the bed
what signs are we looking for in Beurger’s test
- Pallor at Buerger’s angle
- Hyperaemia/Rubor when legs hanging over the side of the bed
what can chronic limb ischaemia lead to
critical limb threatening ischaemia
Define critical limb-threatening ischaemia
the severe end stage of PAD, characterized by chronic, inadequate blood supply to the limb, leading to ischaemic rest pain, non-healing ulcers, or gangrene for more than 2 weeks
Differential Diagnoses to CLI
- Spinal stenosis (‘neurogenic claudication’): pain from the back radiating down the lateral aspect of the leg. Pain relieved by sitting.
- Acute limb ischaemia: Sx <14 days, acute onset, presenting within hours
which part of the body can CLI increase risk to
Caridovascular: monitor BP, BM, Lipid profile and ECG
CLI conservative Mx
- Smoking cessation
- Regular excercise (to encourage the development of new blood vessels and establishment of a collateral circulation)
- Weight loss
- healthy balance diet
CLI medical Mx
- Atorstatin 80mg
- Anti-PLT: Clopidogrel 75mg
- Optimise DM control
CLI surgical Mx
PAD 1st line Tx
Supervised exercise programs: improve walking distance, reduce symptoms, and enhance quality of life for individuals
- 2hr weekly for 12wks
Define Percutaneous Transluminal Angioplasty (PTA)
minimally invasive endovascular procedure used to reopen narrowed or blocked arteries in PAD (w/without stenting)
PTA indications
- short stenotic lesions
- high risk patients
- Intermittent Claudication (IC) affecting daily life
- Critical Limb-Threatening Ischaemia
- Significant arterial stenosis or occlusion
limp amputation indications
- patients who are unsuitable for revascularisation
- ischaemia causing incurable symptoms or gangrene leading to sepsis.
- Critical Limb-Threatening Ischaemia (CLTI)
