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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, oikilothermy
Special laboratory:
- ankle/brachial index often < 0.4
- arteriography allows for endovascular revascularization
a) anticoagulation with heparin prior to arteriography
b) 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
General
critical limb ischemia
References
- 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: 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: 36988592
https://www.nejm.org/doi/10.1056/NEJMoa2212754