Critical Limb Ischaemia

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Critical leg ischaemia is a lack of blood flow that endangers all or part of the leg and is usually defined as experiencing persistent and recurring pain while at rest, for more than two weeks, or ulceration or gangrene of the foot.

What is Critical Limb Ischaemia ?

In the UK around 20 000 patients per year develop critical limb ischaemia and this is increasing as the population becomes more elderly.

 

Many patients with critical limb ischaemia are elderly and frail, and this is reflected in the prognosis of the condition.  Even with treatment, 25% of these patients die within a year and only half survive more than 5 years, mainly due to deaths from heart attack and stroke.  Treatment aims are relatively short term and focus on quality of life as well as long term durability of any procedure.

 

Without treatment, critical limb ischaemia will progress, causing worsening pain and debility.  Ulcers develop on the lower leg and foot, and ultimately gangrene sets in.  If the problem is left too late it can become impossible to salvage the leg and amputation may become the only way to save the patient's life.

 

Most patients suffering from critical limb ischaemia have other serious medical conditions, and it is important to make sure these are as well treated as possible.  In many cases for instance, attention from a cardiologist can improve cardiac output to such an extent that the limb improves without any specific intervention to its blood supply.

 

Duplex scanning is the first method used to assess the affected limb and establish where the main blockages are that are limiting the blood flow.  Other methods may sometimes be needed, for example angiography, but in most cases duplex scanning is sufficient to plan treatment.

What part of the body does it affect?

Critical limb ischaemia affects the leg and foot. 

What are the symptoms?

The pain of severe limb ischaemia is felt in the toes and forefoot and is typically worse at night when cardiac output drops.  Patients wake up in the early hours with severe pain, relieved by hanging the leg out of the bed allowing blood to flow down to the foot.  Some patients take to sleeping in a chair.  Many patients get up and walk around in the night which stimulates flow and reduces pain.  During the day the patient may suffer short distance intermittent claudication.  This pattern of symptoms: calf claudication by day and rest pain in the toes at night is strongly suggestive of critical limb ischaemia. 

What are the treatment options?

Is the condition preventable? If so, how?

Prevention is through good cardiovascular health: diet, not smoking and controlling blood pressure and cholesterol. 

What should I do next?

For more information on critical limb ischaemia or for a consultation with a vascular specialist, contact us for an appointment. 

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