Chronic Limb Ischemia

Chronic limb ischemia

By
Dr.Ahmed Abdul-Ameer Daffar
( ( Cardio-Thoracic & Vascular Surgeon

Asymptomatic

Intermittent claudication
Rest pain
Ischemic ulceration
The end stage of vascular insufficiency is frank tissue infarction or gangrene.

Clinical evaluation

Features of chronic ischemia

Absent distal pulse
Muscle atrophy
Brittle nails
Hair loss
Etc…

Physical Examination

Reduced ABI
Color duplex scanning
Traditional angiography
CTA
MRA
Investigations

Conservative measures

Control of Hypertension, hyperlipidemia and D.M.
Smoking abstinence
Graduated exercise program
Control of weight
Pharmacologic agents
Platelet inhibitors such as aspirin
Vasodilating agents such as tolazoline
Hemorrheologic agents such as pentoxifylline
Treatment


Percutaneous Trans-luminal Angioplasty
Bypass surgery
Endarterectomy
Amputation ( last option )

Surgery

Thank you