You are on page 1of 20

CRITICAL LIMB ISCHEMIA

DEFINITION
Chronica ischemic rest pain And/or Proven arterial occlusive disease

Ulcers, or gangrene
Fontaine classification (stage III-IV) or Rutherford classification (grades 4-6)

Severe manifestation of PAD

EPIDEMIOLOGY
PAD affects 8 to 10 million Americans and is associated with a threefold to sixfold increased risk of cardiovascular morbidity and death compared with individuals without PAD.

Patients with CLI represent approximately 1% of the total number of patients with PAD, with overall mortality in these patients approaching 50% at 5 years and 70% at 10 years.

Patients with CLI also have a greater risk of sustaining cardiovascular ischemic events than those with PAD alone.

15%
Asymptomatic

50%

Classic (Typical) Claudication

33%
Atypical Leg Pain (functionally limited)

1%-2%

Critical Limb Ischemia

Obstructive atherosclerotic disease Thromboembolic disease

Vasculitis

ETIOLOGY
In situ thrombosis Related to hypercoagulable states Popliteal entrapment

Cystic adventitial disease

Regardless of the etiology, the pathophysiology of CLI is a chronic and complex process that affects the macrovascular and microvascular systems, as well as surrounding tissues.

DIAGNOSTIC
Patient History Physical examination Non-invasive tests Invasive tests

PATIENT HISTORY
What is your typical activity level? Do you experience any discomfort in the calf, thigh, buttock or hip area that occurs with walking, climbing stairs? Describe the symptom, onset, duration and resolution? Do you experience rest pain, leg pain when in bed? Have you had any sores or skin ulcerations that wont heal? Any changes in the color, temperature or appearance of your skin? Any problems with impotence or pain in your genitals?

NON-INVASIVE TEST
ABI (Ankle/Brachial Index) Ultrasonography MRA (Magnetic Resonance Arteriography)

THE ANKLE BRACHIAL INDEX

Normal 0.95-1.2 PAD <0.90 Rest pain/ulceration <0.40

ULTRASONOGRAPHY

MRA (MAGNETIC RESONANCE ARTERIOGRAPHY)

INVASIVE TEST
Peripheral Angiogram

TREATMENT
GOALS
Relieve ischemic Pain Heal ischemic ulcers Prevent limb loss Improve patient Function and QOL Prolong survival

Medical

Endovascular therapy

Surgery

MEDICAL TREATMENT
Risk factor modification

Exercise therapy

Drugs therapy

ENDOVASCULAR THERAPY
Peripheral Transluminal Angioplasty
Peripheral Stenting Atherectomy Laser Thrombolytic Therapy (adjunctive)

SURGERY
Bypass graft

Amputation

Endarterectomy

T.H.A.N.K.Y.O.U

You might also like