Chronic limb-threatening ischemia
A Farber - New England Journal of Medicine, 2018 - Mass Medical Soc
New England Journal of Medicine, 2018•Mass Medical Soc
Key Clinical Points Chronic Limb-Threatening Ischemia Chronic limb-threatening ischemia
typically manifests as ischemic pain in the distal leg or foot while the patient is at rest, as
tissue loss, or as both. Patients with chronic limb-threatening ischemia are at a high risk for
leg amputation, cardiovascular complications, and death. The majority of patients with
chronic limb-threatening ischemia have clinically significant infrainguinal arterial occlusive
disease. Timely revascularization substantially improves rates of limb salvage. Surgical and …
typically manifests as ischemic pain in the distal leg or foot while the patient is at rest, as
tissue loss, or as both. Patients with chronic limb-threatening ischemia are at a high risk for
leg amputation, cardiovascular complications, and death. The majority of patients with
chronic limb-threatening ischemia have clinically significant infrainguinal arterial occlusive
disease. Timely revascularization substantially improves rates of limb salvage. Surgical and …
Key Clinical Points
Chronic Limb-Threatening Ischemia
- Chronic limb-threatening ischemia typically manifests as ischemic pain in the distal leg or foot while the patient is at rest, as tissue loss, or as both.
- Patients with chronic limb-threatening ischemia are at a high risk for leg amputation, cardiovascular complications, and death.
- The majority of patients with chronic limb-threatening ischemia have clinically significant infrainguinal arterial occlusive disease.
- Timely revascularization substantially improves rates of limb salvage.
- Surgical and endovascular revascularization are currently used to treat chronic limb-threatening ischemia; randomized trials are in progress to compare outcomes of these strategies in patients who are candidates for both.
- Primary amputation is used to treat chronic limb-threatening ischemia in patients for whom revascularization is not possible, contraindicated, or futile.
- Recommended medical therapies include aspirin, a statin, and control of blood pressure and glycemia. Smoking cessation should be encouraged.
- Patients with chronic limb-threatening ischemia and foot infection typically receive systemic antibiotic agents and undergo incision and drainage of any foot abscess.
The New England Journal Of Medicine