chronic limb-threatening ischemia

Etiology

• see critical limb ischemia

Pathology

• see critical limb ischemia

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, poikilothermy (cool extremity)

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

Complications

• tissue necrosis
• compartment syndrome from tissue swelling after reperfusion

Management

• referral for revascularization is indicated in patients with rest pain, ulceration, or gangrene
  • endovascular revascularization generally preferred
    • minimally invasive
    • lower risk for perioperative adverse events vs surgical revascularization
  • surgical revascularization recommended for long chronic total occlusions, multisegment disease
• transcatheter arterialization of deep veins may benefit patients not amenable to treatable with conconventional arterial revascularization
• also see critical limb ischemia

More general terms

• critical limb ischemia