Chronic critical ischaemia of the legs

Summary

Chronic critical ischaemia of the lower limb is the most severe form of peripheral arterial occlusive disease. It is characterised by acral rest pain and an ankle arterial pressure <50 mmHg and a toe arterial pressure of <30 mmHg for at least two weeks. If trophic lesions are present, then an ankle pressure <70 mmHg and a toe pressure < 50 mmHg are already sufficient for diagnosis of chronic critical ischaemia. The aim of treatment is limb preservation and a reduction in the cardiovascular mortality and morbidity. For this to be achieved, the time to diagnosis and the time to revascularisation must be as short as possible. It is therefore important that patients with foot pain at rest undergo angiological work-up as rapidly as possible, especially if they also have risk factors for critical ischaemia (diabetes, renal failure). The same applies to patients with trophic skin lesions (fissure, ulcer) that do not heal within three weeks.

Revascularisation is the most important therapeutic measure. Inhibition of platelet aggregation, optimum analgesia and early use of antibiotics if signs of an infection are present, are further important measures in addition to the treatment of cardiovascular risk factors. Amputation is the last therapeutic option.

Keywords

Ischaemia - revascularisation - PAD

• References

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