Limb Ischemia

Definition

• Limb Ischemia: Occurs when blood flow to the extremities (hands, feet, or legs) is restricted, leading to insufficient oxygen supply.
• Types of Limb Ischemia:
  • Acute Limb Ischemia: Occurs suddenly and is highly treatable with rapid surgical care.
  • Chronic Limb Ischemia (Critical Limb Ischemia): Develops over time, leading to severe pain even at rest.

Complications

• Acute Limb Ischemia: Delayed treatment (beyond 6-12 hours) can lead to severe complications such as permanent disability, amputation, or even death.
• Critical Limb Ischemia: Severe condition that requires comprehensive treatment to avoid amputation.

Causes

• Acute Limb Ischemia:
  • Embolism
  • Thrombosis
  • Rare cases: Dissection or trauma
• Critical Limb Ischemia:
  • Advanced stage of peripheral artery disease (PAD)
  • Result of atherosclerosis (buildup of plaque in artery lining)

Risk Factors

• Smoking
• Diabetes
• High cholesterol
• High blood pressure
• Family history of vascular disease
• Obesity
• Sedentary lifestyle
• Age (men over 60, women after menopause)

Symptoms

• Acute Ischemia Symptoms:
  • Severe pain
  • Loss of pulses
  • Coldness of the limb
  • Paleness of the skin
  • Loss of sensation
  • Leg weakness
• Critical Limb Ischemia Symptoms:
  • Severe pain or numbness in legs and feet at rest
  • Slow-healing sores, ulcers, or infections on toes or feet
  • Gangrene
  • Thickening of toenails
  • Lower temperature in leg/foot compared to the rest of the body
  • Shiny, dry, smooth skin on legs/feet
  • Loss of pulse in legs or feet

Diagnosis and Treatment

• Diagnosis Procedures:
  • Pulse examination
  • Doppler evaluation (measures direction and velocity of blood flow)
  • Angiogram
  • CT Angiography
  • MRI Angiography
• Treatment Aims:
  • Reduce pain
  • Improve blood flow
  • Save the leg
• Treatment Options:
  • Medications
  • Endovascular treatments:
    • Angioplasty and stent
    • Laser atherectomy
    • Directional atherectomy
  • Surgery: Recommended when arterial blockages are not suitable for endovascular treatment

Conclusion

• Importance of early diagnosis and treatment to prevent complications.
• Encourage sharing and subscriptions to stay updated on related topics.