Professional Documents
Culture Documents
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)
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%
33%
Atypical Leg Pain (functionally limited)
1%-2%
Vasculitis
ETIOLOGY
In situ thrombosis Related to hypercoagulable states Popliteal entrapment
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)
ULTRASONOGRAPHY
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