Chronic Limb Threatening Ischaemia Flashcards
What makes chronic ischaemia different from acute?
> 2 weeks duration
What are the symptoms?
Pain at rest
Non-healing wounds
Gangrene
Intermittent claudication
What are the risk factors?
Increasing age
Smoking
Diabetes
Renal disease
Name the causes
Atherosclerosis
Thromboembolic
Buergers
Trauma
Dissection
Vasculitis
Where do most patients have clinically significant occlusion?
Infrainguinal region
Describe a clinical examination
Absent ankle pulses
Rubor
Thin/shiny skin
Absence of hair
Increased cap refil
What investigations are done?
ABPI
Doppler
Duplex
CTA
What are the main treatment options?
Medical
Surgical - endovascular, bypass, amputation
When would endovascular therapy be favoured?
High anaesthetic risk
Limited life expectancy
Minor tissue loss
Discrete occlusive disease
Inadequate autogenous vein
When would bypass be favoured?
Major tissue loss
Occlusive disease long and diffuse
Good target vessel
Single segment great saphenous vein
What are the three key points of bypass?
Inflow
Conduit
Outflow
What are the two types of bypass?
Anatomical
Extraanatomical
When are extraanatomical procedures used?
Higher risk patients
Hostile abdomen
Lower rates of patency and lower morbidity
What are the types of graft?
Own - greater/lesser saphenous, cephalic, basilar
Prosthetic - PTFE, dacron
What procedures are included in endovascular techniques?
Angioplasty
Stenting
Stent-grafting
