Chronic Limb Ischaemia

Question 1

What is Peripheral Arterial Disease?

Answer 1

• presence of narrowing’s or occlusion of peripheral arteries leading to compromise of blood supply to the lower limbs

Question 2

What are the types of PAD? Define each of them.

Answer 2

• Acute limb ischameia
  
  • sudden decrease in blood supply resulting in ischaemic injury
  • develop in less than 2 weeks
• Chronic limb ischaemia
  
  • chronic narrowing of peripheral arteries resulting in intermittent claudication, rest pain and may threaten limb viability

Question 3

What are the RF of CLI?

Answer 3

• Smoking
• Diabetes
• Age
• Hypertension
• Hyperlipidaemia
• Obesity
• Raised homocysteine

Question 4

What are the clinical features of CLI?

Answer 4

Early

• Asymptomatic
• Intermittent caludication

Later on

• Non healing injuries
• Hair loss
• Erectile dysfunction

Critical ischaemia

• rest pain - worse at night
• Absent foot pulses
• Ulcers
• Gangrene

Question 5

What is Intermittent claudication?

Answer 5

• Cramp-like muscular pain in the lower limbs
• Triggered by exercise
• relieved by rest

Question 6

What Ix would you perform for CLI?

Answer 6

• Bedside test
  
  • ABI
  • Treadmill test
• Imaging
  
  • DUS
  • CT Angio
  • MR Angio
• Interventional
  
  • Digital subtraction angiography

Question 7

Describe more about the ABI

*how its used

*normal range

*interpretation of result

Answer 7

• compares blood pressure at ankle and arm
• normal range: 1.00 - 1.20
• boderline: 0.90 - 1.00
• lower extremity artery disease: <0.9
  
  • moderate disease: 0.5-0.8
  • Severe: <0.5
  • critical: <0.3
• vessel wall calcification (diabetes): >1.2

Question 8

What classifications are used for CLI?

Answer 8

• Rutherford classification
• Fontain classifictaion

Question 9

How would you mx CLI?

Answer 9

Modifiable RF

• Smoking cessation
• Regular exercise

Pharm

• Artovastatin 80mg
• Clopidogrel
• Naftidrofuryl oxalate (peripheral vasodilators)

Revascularisation

• Angioplasty +/- stent
• Remote endarterectomy
• Bypass

Question 10

What is the prognosis like for CLI?

Answer 10

• majority of those with intermittent claudication will develop stable disease
• those with intermittent claudication around 5-10% will develop critical limb ischaemia
• 1-2% of critical LI will require amputation
  *

Question 11

How would critical limb ishcaemia present?

Answer 11

• foot ulceration
• pain at rest for greater than 2 weeks, often at night - not helped by analgesia
• gangrene
• pulses are impalpable

Question 12

What is sunset foot?

Answer 12

• Hyperaemia may occur in association with severe vascular disease
• ABPI higher than 0.3, but seldom greater than 0.5

Question 13

What ABPI is acceptable for compression banding in VV?

Answer 13

>= 0.8