critical limb ischaemia

Question 1

what is critical limb ischaemia?

Answer 1

rest or night pain for greater than 2 weeks, with or without tissue loss such as ulceration.

Question 2

what are the symptoms of critical limb ischaemia?

Answer 2

• history of aching leg pain with intermittent claudication >2 weeks
• present at night and relieved by hanging leg off bed
• evidence of aortoilliac disease;
  claudication of thigh and buttocks, absent/decreased femoral pulses, erectile dysfunction
• cool peripheries

Question 3

what signs would yo look for on examination?

Answer 3

• non healing ulcer/ wound
• gangrene
• absent or diminished foot pulses

-Reactive hyperaemia: the leg is pale when elevated and red when lowered

Question 4

what are the surgical options for someone with critical limb ischaemia?

Answer 4

Revascularisation: intervention is required in 65% of patients with critical limb ischaemia

Endovascular intervention: angioplasty or stenting is offered to 40% of patients and should be offered for short occlusions

Bypass surgery: offered to 25% of patients; preferred for long occlusions

Amputation: considered if revascularisation has been unsuccessful or is inappropriate
Primary amputation is offered to 15% of people presenting with a new diagnosis of critical limb ischaemia

Question 5

what are the options for conservative management of PAD?

Answer 5

conservative management: appropriate for only 20% of patients 
Multidisciplinary team (MDT) referral: all patients should be referred to a vascular MDT unless inappropriate, such as palliative patients

Analgesia: paracetamol with either a weak or strong opioid, depending on pain severity

Supervised exercise programme: first-line for patients with chronic limb ischaemia and minimal symptoms such as intermittent claudication, but is less appropriate for critical disease