أ.م.د. احمد عبداالمير دفار ( اختصاصي جراحة الصدر و القلب و االوعية
) الدموية
1
Chronic limb ischemia
Objective : To show the definition, etiology and management
of chronic limb
ischemia
Clinical evaluation
- Asymptomatic
- Intermittent claudication
- Rest pain
- Ischemic ulceration
- The end stage of vascular insufficiency is frank tissue infarction or gangrene.
Physical Examination
Features of chronic ischemia (absent distal pulse, muscle atrophy, brittle nails, hair loss,
etc…)
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 agents.
There is no objective evidence that any of the vasodilators,
such as
tolazoline
,
nicotinyl
, or
cyclandelate
, improve blood flow or symptoms in
an ischemic extremity.
Hemorrheologic agents
such as
pentoxifylline
are the only class of drugs with
objective evidence of improvement in walking distance.
أ.م.د. احمد عبداالمير دفار ( اختصاصي جراحة الصدر و القلب و االوعية
) الدموية
2
Surgery
- Percutaneous Trans-luminal Angioplasty
- Bypass surgery
- Endarterectomy
- Amputation ( last option )