Chronic Arterial Insufficiency

Chronic limb ischemia

Dr.Ali Mohsin Al-Sinjery
( ( Cardio-Thoracic & Vascular Surgeon

Asymptomatic

Intermittent claudication : cramp- like pain felt in the muscles that is brought on by walking and typically relieved by standing still , most common in the calf muscles due to superficial femoral artery occlusive disease and when occures in the buttock due to aorto- iliac disease associated with sexual impotence called (Leriche’s syndrom)
Dependent rubor(purpule or red when hanging down)….sunset foot sign
Rest pain typically is felt in the foot
Ischemic ulceration
The end stage of vascular insufficiency is frank tissue infarction or gangrene.

Clinical evaluation

Features of chronic ischemia
Absent or diminished distal pulses
Muscle atrophy
Brittle nails
Hair loss
Delayed capillary refilling
Arterial bruit


Physical Examination

Reduced ABI

Color duplex scanning
Traditional angiography
CTA
MRA
Investigations

Conservative measures

Control of Hypertension, hyperlipidemia and D.M.
Smoking abstinence
Graduated exercise program
Control of weight
Pharmacologic agents
Platelet inhibitors such as aspirin
Vasodilating agents such as pentoxifylline
Antilipid drugs such as statin

Treatment

Percutaneous Trans-luminal Angioplasty (ballon and stent)
Bypass surgery: aortofemoral by pass,femoropopliteal bypass,femoro-femoral bypass and axillofemoral bypass
Endarterectomy
Amputation ( last option )

Surgery

Thank you