Chronic Lower Limb Ischaemia Flashcards
What is a serious complication of lower limb ischaemia?
Ulceration
Gangrene
What is the common presenting feature of chronic limb ischemia?
How is described and often remedied by patients?
Intermittent claudication
Severe cramp pains on exercise, usually in calf/buttocks.
Patients say it stops them sleeping, and can be relieved by dangling foot over edge of bed or standing on a cold floor.
What are the signs of chronic limb ischaemia?
- Cold limbs
- Dry skin with lack of hair
- Pulses diminished or absent
- Ulceration may occur with discolouration/gangrene
What are the risk factors for chronic limb ischaemia?
- Smoking
- Hypercholesterolaemia
- Diabetes
- Hypertension
Name 3 differential diagnoses of chronic limb ischaemia?
- Spinal cord claudication (pulses present)
- OA (hip/knee pain at rest)
- Peripheral neuropathy (numbness & tingling)
- Buerger’s disease (young males, heavy smokers)
- Venous claudication (bursting pain on walking with history of DVT)
What investigations should be carried out in chronic limb ischaemia?
- Peripheral arterial examination - estimates anatomical level
- ABPI
What is Ankle-brachial pressure index?
When is it falsely-positive?
Measure pressure of blood flow in posterior/anterior tibial artery compared to brachial artery (Pleg/Parm)
ABPI 0.4-0.9 associated with intermittent claudication
ABPI <0.4 = critical limb ischaemia
If arteries calcified, ABPI falsely raised.
What is the management for chronic limb ischaemia?
Medical:
- Aggressive risk factor management (stop smoking!, treat Hypercholesterolaemia)
- Pts with diabetes need chiropody and careful glucose management
Surgical:
- Only considered when disease impacts on lifestyle and risk factors addressed
- Percutaneous transluminal angioplasty = first option
- Bypass procedures
- If severe and non-reperfusable = amputation considered
