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Critical limb
ischemia (Clinical
presentation (Leg pain (Character
…
Critical limb
ischemia
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Aetiology
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Vascular
Thrombus e.g. PVD
Embolus e.g. AF, mural thrombi, aneursym
Dissection
Clinical
presentation
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Leg pain
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Timing
Constant, persisting
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Diagnosis
Examination
Peripheral vascular - pallor/mottling, skin atropy,
cold, absent pulses, reduced sensation and power
Neuro - reduced sensation, reduced power
Cardio - AF, R-R/R-F delay if dissection
Investigations
Bedside
Obs - low BP, high HR if dissection
ECG - previous ischemia
ABPI - <0.5 (critical)
Bloods
FBC, CRP, U+E, LFT (nil)
Imaging
CXR/AXR - dissection
Colour duplex USS - diagnostic
MR/CT angiography - site and extent
ECHO - mural thrombi
History
HPC - sudden onset, 6Ps
PMH - PVD, trauma, prev surgery
DH - anticoagulants/antiplatelets
FH - PVD, CVD
SH - smoking, diet, alcohol
Management
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Definitive
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Conservative
Referral to vascular ASAP
Lifestyle (smoking cessation,
manage comorbidities, exercise programme)
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