Critical limb Ischaemia

Question 1

What is it?

Answer 1

Atherosclerotic disease of the arteries of the lower limbs

Same development as Coronary artery disease

Question 2

Risk factors

Answer 2

• male
• age
• hypercholesteremia
• smoking
• exercise

Question 3

Symptoms STAGES

Answer 3

STAGE 1: partial obstruction of blood vessel
STAGE 2A: claudication when walking more than 200m
STAGE 2B: claudication when walking less than 200m
STAGE 3: claudication at rest
STAGE 4: necrosis/gangrene

other symptoms: pallor, tissue loss, hair loss, increased temperature,increased capillary refill time

Question 4

special tests

Answer 4

Ankle branchial pressure index- should be 1
Ratio between Ankle and Brachial
Buerger’s test:
-lift up leg: if angle <20 and pallor = CRITICAL ISCHAEMIA
-swing legs off bed: slow return of colour or HYPEREMIC SUNSET FOOT
-slow return: 1/3 capillaries closed
-hyperemic sunset foot: auto regulation lost in capillaries

Question 5

Treatment

Answer 5

BMT:

• smoking cessation
• diabetes control
• anticoagulants
• statins
• BP control

If mild/severe:

• Surgical bypass
• angioplasty
• stent

If severe/critical:

• Endovascular revascularisation
• amputation

Question 6

complications of surgical bypass?

Answer 6

• bleeding
• infection
• pain
• DVT
• PE
• nerve ending damage

Question 7

Aetiology?

Answer 7

• atherosclerosis
• vasculitis
• Buerger’s disease: inflammation of the small and medium arteries