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Chronic Limb Ischaemia (Presentation (Classification (ABPI >1.4…

- - - - Spinal Claudication
        
        Path Nerve compression
        
        Site Ill-defined / whole leg
        
        Pain
        Positional onset
        Better up stairs
        Burning pain
        Eased sitting forward
        
        Exam Normal
      - Arterial
        
        Path Vascular insufficiency
        
        Site Usually calf or buttock
        
        Pain Set distance: reproducible
        
        Worse up stairs
        
        Cramping
        
        Eased by standing rest
        
        Exam Evidence of PVD
  - - - Persistent rest pain requiring analgesia for ≥2wks
      - Ulceration or gangrene
    - - Especially @ night
      - Usually felt in the foot
      - Pt. hangs foot out of bed
      - Due to ↓ CO and loss of gravity help
  - - - Buttock claudication and wasting
      - Erectile dysfunction
      - Absent femoral pulses
  - - - Calcification: CRF, DM
    - - Normal
    - - Asymptomatic Fontaine 1
    - - Claudication Fontaine 2
    - - Rest pain Fontaine 3
    - - Ulceration and gangrene Fontaine 4
- - - - ~80% improve or stay the same
      - 20% deteriorate, 1% lose their limb
      - 60% mortality @ 5yrs: cardiovascular disease
  - - - Indications
        V. short claudication distance (e.g. <100m)
        Symptoms greatly affecting pts. QoL
        Development of rest pain
      - Pre-op Assessment
        Need good optimisation as likely to have
        cardiorespiratory co-morbidities.
      - Practicalities
        Need good proximal supply and distal run-off
        Saphenous vein grafts preferred below the IL
        More distal grafts have ↑ rates of thrombosis
      - Classification
        Anatomical: fem-pop, fem-distal, aortobifemoral
        Extra-anatomical: axillo-fem / -bifem, fem-fem
        crossover