chronic limb-threatening ischemia
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Etiology
Pathology
Clinical manifestations
- > 2 weeks of ischemic pain at rest
- non-healing arterial ulcers or wounds
- gangrene attributable to peripheral arterial disease
- inability to exercise due to arterial ulcers &/or ischemic pain at rest
- pulseless, pallor, paralysis, oikilothermy
Diagnostic procedures
- ankle/brachial index often < 0.4
- arteriography allows for endovascular revascularization
- anticoagulation with heparin prior to arteriography
- identify the site & nature of arterial occlusion
Radiology
- CT angiography allegedly results in clinically significant treatment delays[1]
Complications
- tissue necrosis
- compartment syndrome from tissue swelling after reperfusion[1]
Management
- see critical limb ischemia
- transcatheter arterialization of deep veins may benefit patients not amenable to treatable with conconventional arterial revascularization
More general terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ Farber A Chronic Limb-Threatening Ischemia N Engl J Med. 2018 Jul 12;379(2):171-180 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29996085 https://www.nejm.org/doi/10.1056/NEJMcp1709326
- ↑ Shishehbor MH et al. Transcatheter arterialization of deep veins in chronic limb-threatening ischemia. N Engl J Med 2023 Mar 30; 388:1171. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36988592 https://www.nejm.org/doi/10.1056/NEJMoa2212754