Chronic Limb Ischaemia

Question 1

What is chronic limb ischaemia?

Answer 1

Peripheral arterial disease that results in symptomatic reduced blood supply to the limbs.

Question 2

Typical aetiology?

Who?

Answer 2

Atherosclerosis

15-20% >70 year olds

Question 3

RF?

Answer 3

SMOKING

HTN

DM

HYPERLIPIDAEMIA

increasing age

fam history

obesity

Question 4

How do we classify the symptoms? And provide the symptoms.

Answer 4

Fontaine Classification

S1 = assymptomatic

S2 = intermittant claudication

S3 = ischaemic rest pain

S4 = Ulcertation and gangrene

Question 5

Diagnosis?

Answer 5

Dx is clinical with a supplemented ABPI score.

Severity : ABPI

Normal : >0.9

Mild : 0.8-0.9

Moderate : 0.5-0.8

Severe : <0.5

** Any ABPI value >1.2 should be interpreted with caution, as calcification and hardening of the arteries may cause a falsely high ABPI. **

Question 6

Investigations?

Answer 6

Should however initially be investigated with a doppler.

Do a CT angiography once have diagnosis.

CVS risk assessment also.

Question 7

Management?

Answer 7

Lifestyle changes

Statin therapy - atorvostatin (80mg)

Antiplatelet - clopidogrel 75mg

Optimise DM control

or

Surgical management

*only offer if RF management has been discussed and supervised exercise has failed*

Angioplasty (balloon operation) or Bypass grafting

Question 8

Complications?

Answer 8

Gangrene, amputations,