Chronic Limb Ischaemia Flashcards
What is chronic limb ischaemia?
Peripheral artery disease that results in symptomatic reduced blood supply to the limbs
Typically caused by atherosclerosis
Symptoms for > 2 weeks
Risk factors of chronic limb ischaemia
Smoking
Diabetes
Hypertension
Hyperlipidaemia
Clinical features of chronic limb ischaemia
Intermittent claudication
Rest pain
Slow cap refill
What is Buerger’s test?
Assessment of arterial sufficiency
- lie patient flat
- raise leg until pale
- lower leg until colour returns
What is Buerger’s angle?
Angle at which the limb goes pale
<20 degrees = severe ischaemia
What is Leriche Syndrome?
Form of PAD affecting aortic bifurcation
Presents with buttock/thing pain and erectile dysfunction
Signs of aorto-illiac obstruction
Claudication of buttocks, thighs & calves
Femoral & distal pules absent
Bruit over aorto-illiac region
Impotence (Leriche)
Signs of illiac obstruction
Unilateral thigh & calf claudication
Bruit over illiac region
Unilateral absence of pulse
Signs of femoropopliteal obstruction
Unilateral calf claudication
Femoral pulse palpable
Signs of a distal obstruction
Claudication in foot
Distal pulses absent
Differential diagnosis for chronic limb ischaemia
Spinal stenosis
- pain of initiation of movement
- relieved only by sitting
Investigations for suspected chronic limb ischaemia
ABPI
- > 0.9 = normal
- 0.8-0.9 = mild
- 0.5-0.8 = moderate
- <0.5 = severe
Doppler ultrasound
Cardiovascular risk assessment
- blood pressure
- lipid profile
- blood glucose
- ECG
Conservative management of chronic limb ischaemia
Lifestyle advice
- smoking cessation
- exercise
- weight loss
Statin
Clopidogrel
Diabetes control
Surgical management of chronic limb ischaemia
Offered if:
- risk factor modification discussed
- supervised exercise failed to improve symptoms
Angioplasty
Bypass grafting
Amputation for patients unsuitable for revascularisation
