Critical Leg Ischemia and Treatment
Detected with Objective Vascular Diagnostic Tools; It is a peripheral arterial disease in which there is tissue loss accompanied by trophic disorders such as chronic rest pain, ulcer, and gangrene due to severely reduced blood flow.
The difference between acute limb ischemia and CBI is that in acute limb ischemia, the etiology is thrombosis or peripheral artery disease. thromboembolism.
- Pain;
- High dose analgesic requirement
- Opioid requirement
- Ulcer etiology
- Gangrene
CBI PATHOPHYSIOLOGY
- Arterial flow decrease, hypoxia
- Disruption of microcirculation
- Neuropathy
- DM (mixed; ischemia+neuropathy)
- Impaired skin nutrition
- Impaired endothelial function
- Impaired inflammatory response
- Impaired sympathetic autoregulation
RESULT
- REST PAIN
- TROPHIC CHANGES
- IMPAIRED WOUND HEALING
RISK FACTORS
- Age
- Smoking
- DM
- Cardiovascular events
- HT
- Hyperlipidemia
- Cerebrovascular accident
- Other accompanying vascular pathologies
TREATMENT
- The first aim is to relieve pain
- Healing of ulcer
- Prevention of leg loss
- Improvement of life functions
- MEDICATION TREATMENT
- REMOVATION OF RISK FACTORS
- PROSTOGLANDIN STUDIES
- ADDITIONAL TREATMENT OPTIONS
- RECOMMENDATIONS
TASC II recommendation
- Previous studies support the use of prostonoids in CBI in healing ischemic ulcers and reducing amputation. Evidence A
- With this However, recent studies support that prostonoids are not useful for recovery from amputation. Evidence A
- There is no other drug in pharmacotherapy. Evidence B
ADDITIONAL TREATMENT OPTIONS
- Therapeutic angiogenesis
- Wound care
- Mechanical instruments
- Pneumo otic compression applications
- Spinal cord stimulation
- Hyperbaric oxygen
- Lumbar sympathectomy
- Ultrasound
RECOMMENDATIONS
- Observing the feet every day with the help of a mirror if necessary
- Protecting endangered areas of the extremity
- Regular use of medication
- Protecting especially edematous extremity areas from pressure
- Patients should have their blood pressure, blood sugar and lipid levels checked regularly
- Choosing appropriate shoes and slippers
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