Chronic Lower Limb Ischemia Flashcards
What is claudication?
Muscle ischemia
Risk factors for intermittent claudication
Male Older Diabetes Smoking Hypertension Hypercholesterolemia Fibrinogen
Non-invasive investigation of lower limb ischemia
Measurement of ABPI
Duplex ultrasound scanning
Invasive investigation of lower limb ischemia
Magnetic resonance agiography
CT angiography
Catheter angiography
What is ABPI?
Ankle pressure (mHg) divided by brachial pressure (mmHg)
Normal ABPI
0.9-1.2
Claudication ABPI
0.4 - 0.85
Severe ABPI
0 - 0.45
Treatment for lower limb ischemia
Slowing progression - SMOKING - lipid lowering - antiplatelets - hypertension Rx - diabetes Rx - life style issues INFORMATION
- exercise training
- drugs CILOSTOZOL
- angioplasty/stenting
- surgery
Exercise training and drugs
1 hour per day
(start with 30 mins 3 times per week for minimum of 6 months)
-CILOSTOZOL
Surgery for lower limb ischemia
Endaractomy
Bypass
Autologous bypass
Made with vein
prosthetic = dacron, aPTFE
What is critical limb ischaemia?
- When you have pain at REST (lying, sleeping)
- Ulcers/gangrene (trauma, footwear)
Symptoms of critical limb ischemia
Pain at rest…..rest pain Toes and forefoot Requires strong analgesia Worse at night Helped by sitting and putting the leg in a dependent position Helped by getting up and walking about
Risk factors for amputation in limb ischemia?
Smoking
Diabetes
Smoking
major risk factor for peripheral arterial disease (>coronary)
1-in-10 of IC patients will lose a leg every 5 years if the continue to smoke
Diabetes
Incidence 2-5% population
45% of all major amputees diabetic
