Limb Ischaemia, Ulcers, Gangrene Flashcards
Definition of chronic limb ischaemia
Ankle artery pressure <50mmHg (toe <30mmHg)
AND either:
- Persistent rest pain requiring analgesia for ≥2wks
- Ulceration or gangrenes
Causes of chronic limb ischaemia
Atherosclerosis
Rarely vasculitis
Spectrum of chronic limb ischaemia
1) Intermittent claudication
2) Critical limb ischaemia (fontaine 3/4)
3) Leriche’s syndrome
4) Buerger’s syndrome
Intermittent claudication sx
Cramping pain after walking set distance
Vessel responisble for intermittent claudication in calf
superficial femoral disease
Vessel responsible for intermittent claudication in buttock
iliac disease
Critical limb ischaemian sx
Rest pain (night)
ulceration
gangrene
Leriche’s syndrome
Aortoiliac occlusive disease
Triad:
- Buttock claudication/wasting
- Erectile dysfunction
- Absent femoral pulses
Buerger’s disease aka
Thromboangiitis Obliterans
Buerger’s disease risk factors
Young, male, smoker
Buerger’s disease pathology
Acute inflammation and thrombosis of arteries/veins in hands and feet –> ulceration and gangrene
Buergers test
lift leg until pale
≥90: normal
20-30: ischaemia
<20: severe ischaemia
Signs of chronic limb ischaemia
Pallor
Pulseless
Pain
Perishingly cold
Parasthesia/paralysis
Fontaine classification of chronic limb ischaemia
1) Assymptomatic
2) Intermittent claudication: a. >200m b.<200m
3) Ischaemic rest pain
4) Ulceration/gangrene
Rutherford classification of chronic limb ischaemia
1) Mild claudication
2) Moderate claudication
3) Severe claudication
4) Ischaemic rest pain
5) Minor tissue loss
6) Major tissue loss
Investigations for chronic limb ischaemia
Doppler waveforms
ABPI
Walk test
Imaging
Imaging Ix for chronic limb ischaemia
colour duplex US
CT/MR angiogram with gadolinium contrast
Digital subtraction angiography
Doppler waveforms
Normal: triphasic
Mild stenosis: biphasic
Severe stenosis: monophasic
Medical mx of chronic limb ischaemia
RFs mx
Beta Blockers in intermittent (NOT critical limb ischaemia)
antiplatelets
analgaesia
Interventional mx of chronic limb ischaemia
Endovascular: percutaneous transluminal angioplasty/stenting
Surgical reconstruction
Acute ischaemia definition
< 14 days
Severity of acute limb ischaemia
Incomplete: limb not threatened
Complete: limb threatened: Loss of limb unless intervention within 6hrs
Irreversible: requires amputation
Causes of acute limb ischaemia
1) Thrombosis in situ (60%)
2) Embolus (30%)
3) Others: graft occlusion, trauma, aortic dissection
Where do majority of emboli causing limb ischaemia form?
left atria in AF (80%)
