1
Chronic limb ischemia
Clinical evaluation
- Asymptomatic
-
Intermittent claudication:
cramp-like pain is felt in the muscles and most commonly
in the calf which is typically occurs during walking and relieved by stand still. When
occurs in the thigh or buttock and associated with impotence called
Leriche's
syndrome
due to aorto-iliac disease.
- Rest pain
- Ischemic ulceration
- The end stage of vascular insufficiency is frank tissue infarction or gangrene.
Physical Examination
Features of chronic ischemia (absent or diminished distal pulse, muscle atrophy, brittle
nails, hair loss, delayed capillary refilling and rubor on dependency with pallor on
elevation called sunset foot sign and arterial bruits)
Investigations
- Reduced ABI.
- Color duplex scanning
- Traditional angiography
- MRA and CTA are used to determine the extent and type of obstruction.
Treatment
Conservative treatment
- Hypertension, hyperlipidemia, and diabetes mellitus should be controlled.
- Smoking should be stopped.
-
A graduated exercise program to improve walking efficiency, endothelial function,
and metabolic adaptations in skeletal muscle.
- Control of weight
- Pharmacologic agents
Platelet inhibitors
such as
aspirin
Vasodilating drugs
, such as
cilostazole
improve blood flow or symptoms in an
ischemic extremity.
Hemorrheologic agents
such as
pentoxifylline(Trental).
2
Surgery
- Percutaneous Trans-luminal Angioplasty(balloon and stent)
- Bypass surgery:aortofemoral bypass,femoropopliteal bypass, femoro-femoral
bypass and axillofemoral bypass
- Endarterectomy
- Amputation ( last option )