Lower limb ischaemia
EBM Guidelines
Mar 20, 2017 • Latest change Jul 7, 2020
Table of contents
- Essentials
- Signs and symptoms of chronic ischaemia evd
- Conservative treatment of intermittent claudication evd
- Surgical management of chronic ischaemia with intermittent claudication evd
- Critical ischaemia evd
- Symptoms and diagnosis of acute ischaemia
- Surgical treatment of acute and critical ischaemia evd
- References
Extract
- Acute lower limb ischaemia is in most cases caused by sudden obstruction of an artery due to an embolus or thrombosis. Rare causes that should be kept in mind include aortic dissection and thrombosis of a popliteal aneurysm.
- Chronic lower limb ischaemia is a slowly progressing disease process that is usually caused by an obliterating arterial disease.
- Acute lower limb ischaemia must be recognized and the patient immediately referred for further management.
- Chronic lower limb ischaemia must be diagnosed and its severity (stage) assessed,
as the severity of the condition will determine management approach.
- Mild ischaemia is asymptomatic, but is suggestive of an increased overall cardiovascular risk.
- Moderate ischaemia causes intermittent claudication which, as such, is a benign but troublesome complaint. Claudication may be treated conservatively, but if the condition threatens the work or functional capacity of the patient, a referral to a vascular surgeon is indicated.
- Critical ischaemia manifests itself as pain at rest and may lead to a non-healing chronic leg ulcer and eventually to gangrene. Patients with critical limb ischaemia require urgent referral to a vascular surgeon. If limb ischaemia is complicated by an infection or if a gangrene has developed fast, an emergency referral is indicated.
- If ischaemia is suspected it should be verified by measuring the ankle and brachial pressures with Doppler ultrasonography in all suspected cases of ischaemia. Examination of the patient, see Doppler stethoscopy in diagnostics1.
- A patient suffering from lower extremity ischaemia always has atherosclerosis also elsewhere than in the arteries of the lower extremities (ASO). Consequently, the prevention of coronary heart disease and ischaemic cerebrovascular disorders should be taken care of by controlling the risk factors (hypertension, dyslipidaemia, smoking, diabetes). This has the greatest impact on the patient’s prognosis.
Search terms
ADP, ASO, Amputation, Angioplasty, Arteriosclerosis Obliterans, Aspirin, Atherosclerosis, Cardiology, Embolectomy, Embolism, Foot Ulcer, Gangrene, I70.2, I73.9, I74.3, I79.2*, Intermittent Claudication, Internal medicine, Leriche's Syndrome, Necrosis, PAOD, Surgery, Vascular Surgical Procedures, Vascular surgery, acute lower limb ischemia, ankle-brachial index, chronic ischemia, critical ischemia, doppler stethoscope, ischemic ulcer, lower extremity embolism, percutaneous transluminal coronary angioplasty, posterior tibial artery, rest pain, surgical therapy