Critical limb ischemia

Question 1

Define critical limb ischemia

Answer 1

Pain at rest for more than 2 weeks with ankle SP <50 or toe SP <30.
OR
ulcers/gangrene with ankle SP <50

Question 2

Describe rest pain and location of ulcers

Answer 2

The pain is intense, burning, or tingling in the leg or distal foot worse with elevation and relieved by dependent positions (dangling feet). Can disturb sleep.

Ulcers in the heel or tip of the toes

Question 3

Management?

Answer 3

-Admission and give IV heparin.
-Urgent angiogram (CTA or MRA)
-revascularize by endovascular repair or bypass
-amputation if the last resort

Question 4

What if revascularization failed or what indicates amputation?

Answer 4

If failure: give prostanoids (powerful vasodilators) or pentoxifyllin

Indications of amputation: failure of endovascular repair and surgery. Severe uncontrolled sepsis