chronic lower limb ischemia

Question 1

categories of CLLE?

Answer 1

1. disabling claudication (interfere with lifestyle)
2. non-disabling claudication (not interfering)
3. critical limb ischemia

Question 2

define intermittent claudication? arterial occlusion site with claudication site

Answer 2

crampy pain in the gluteal, thigh, or calf upon walking a certain distance RELIEVED by rest and not worse by standing for long time (this is venous claudication)
NO REST PAIN (that’s critical limb ischemia)

iliac = thigh and gluteal region
Superficial femoral artery = calf

Question 3

lower limb vascular examination?
(inspection, special test/s, palpation, auscultation)

Answer 3

inspect for skin changes, hair loss, ulcers

special test: Buerger’s test
1. pt lying supine, elevate both legs >30 degrees for few seconds
2. inspect the soles and pulp of 5 digits
3. dangle both feet down by allowing pt to sit on edge of bed and inspect for color changes
positive Buerger’s test: feet is pale on elevation and bluish red on dependency (vessels cannot support simple elevation)

palpation:
T = cold
capillary refill = slow
pulses = diminished distant to occlusion site
senses = diminished

auscultation: bruit on stenoses artery

Question 4

nonvascular causes for claudication?

assessment? explain ABI and its values

Answer 4

sciatica, spinal canal stenosis (shooting pain to both legs worse when standing and walking not rapidly relieved by rest)

assessment: blood sugar, lipid profile, RFT
doppler and duplex studies

doppler: obtain systolic BP of brachial and peripheral pulses.
Ankle pressure: use highest PT or DP SBP as numerator
brachial pressure: use highest brachial SBP as denominator

ABI values:
1 = normal
<0.8 = claudication
<0.5 = rest pain
>1.4 = false rise in median calcinosis

Question 5

management of non disabling claudication

Answer 5

1. modify risk factors (smoking, HTN, DB, lipid profile)
2. exercise to max pain tolerance at least 1hr a day (results after 3-6 mo)
3. drug therapy antiplatelet (aspirin, clpidogrel) AND statin

Question 6

management of disabling claudication?

Answer 6

perform angiogram (CTA/MRA) to locate the site and size of occlusion

tx:
1. endovascular repair: angioplasty (examples: percutaneous transluminal angioplasty, balloon angioplasty)
2. surgery (bypass) graft used is saphenous vein/ synthetic graft
3. amputation