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AMP
 

Occurrence of Critical Limb Ischemia

Authors

Stephanie Sheridan, DNP, ANP-C, CNN-NP; Christopher LeSar, MD, FACS, Vascular Institute of Chattanooga
 

Abstract Number
AMP 2018-6

Purpose: Critical limb ischemia (CLI) is the final prognosis of peripheral arterial disease (PAD). The mortality rate for CLI patients from initial diagnosis can surge 20% at 6 months to twenty-fold at 5 years. PAD is a slow, progressive circulation disorder, which is the leading cause of death, worldwide. PAD affects over ten million Americans. PAD is a buildup of plaque in the arteries; the plaque can consist of fat, calcium, cholesterol, fibrous tissue, or other substances in the blood. The plaque causes the arteries to harden and narrow along with a reduced blood flow, which inhibits perfusion of the organs, tissue, and muscle. The narrowed arteries can cause a functional restriction of blood flow through the vessel, which can impede the velocity of the blood flowing to the body. The muscle becomes ischemic from the reduced oxygen supply. Risk Factors: There are multifactorial issues that place patients with PAD at a higher prevalence, such as smoking, diabetes mellitus, hypertension, history cardiovascular disease, chronic lung, and renal disease. Materials and Methods: History of Present Illness: N.F., a 45-year-old patient of Dr. Smith referred to Dr. Christopher LeSar for lower-extremity PAD. She had a previous left below-the-knee amputation (BKA). In July 2017, she was bitten on her ankle by an insect and developed cellulitis of the right foot. She was complaining of right calf claudication and rest pain with an unhealed lesion on the malleolus on the ankle. She has diabetes and blood sugar range 115 to 220. She also has hypertension; blood pressure was 138/70 on this visit. She has hyperlipidemia. She smoked for twelve years (1 pack a day) and she recently stopped approximately 3 weeks ago when the claudication would not subside. Physical Examination: N.F. is awake, alert, oriented, neurologically intact, in no acute distress, head is normocephalic. Abdomen is soft, round, obese, nontender. Bilateral radial pulses are +2. Grip strength is equal. Femoral and popliteal pulses unable to assess due to body hiatus. Dorsal pedal on the right is absent. Posterior tibial pulse on the right is absent. She had a 0.3 cm x 0.3 cm ulcer with red streaking with crusty ends and a trace of edema noted in her right ankle region. Right ankle and shin with warmth and redness. Left BKA. Results: An arterial duplex ultrasound and ankle-brachial index (ABI) of the affected limb was ordered. The ultrasound revealed monophasic flows with total occlusion of the superficial femoral artery (SFA) with a flat toe pressure and ABI 0.32. Arteriogram of the right lower extremity per Dr. LeSar and wound care was initiated by Vascular Institute of Chattanooga Wound Center, and she made a full recovery. Conclusions: Treatment for CLI is not an easy choice; the treatment depends on the patient’s age, comorbidities, severity of limb ischemia, and vascular anatomy. The plan of care for these PAD patients is to continue improving outcomes by increasing community awareness; initiating better-quality wound care, and improved medical therapy to prevent the PAD from progressing to CLI.

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