Document Detail


Chronic critical limb ischemia: diagnosis, treatment and prognosis.
MedLine Citation:
PMID:  10208708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.
Authors:
J D Santilli; S M Santilli
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American family physician     Volume:  59     ISSN:  0002-838X     ISO Abbreviation:  Am Fam Physician     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-04-23     Completed Date:  1999-04-23     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  1272646     Medline TA:  Am Fam Physician     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1899-908     Citation Subset:  AIM; IM    
Affiliation:
Department of Family Practice and Community Health, University of Minnesota School of Medicine, Minneapolis, USA.
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MeSH Terms
Descriptor/Qualifier:
Amputation
Chronic Disease
Critical Illness
Diagnosis, Differential
Humans
Ischemia / diagnosis*,  etiology,  physiopathology,  therapy*
Leg / blood supply*
Pulse
Risk Factors
Wound Healing

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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