Limb Ischemia: Cardiovascular Diagnosis and Management from Head to Toe

Abstract

Peripheral arterial disease (PAD) affects an estimated 27 million people in Europe and North America. Limb ischemia, defined as ischemic rest pain, ischemic ulcerations, or ischemic gangrene, represents the most severe manifestation of PAD and is associated with significant cardiovascular and limb morbidity and mortality. Critical limb ischemia (CLI), defined as limb ischemia symptoms for greater than 2 weeks, is characterized by a cascade of hemodynamically significant macrovascular atherosclerotic obstruction and microvascular changes culminating in decreased muscle perfusion, disrupted muscle energy metabolism, and inflammation. In contrast, acute limb ischemia (ALI) is defined as limb ischemia symptoms characterized by sudden onset of less than 2 weeks duration resulting in hemodynamically compromised limb perfusion. Diagnosis of both ALI and CLI is dependent on history, physical examination, and a combination of anatomic and hemodynamic assessment of the limb. Given that the risk factors for ALI and CLI overlap with risk factors for atherosclerotic coronary and neurovascular disease, the management of limb ischemia is focused on both endovascular or surgical limb salvage and cardiovascular risk factor control. Despite advancements in endovascular and surgical revascularization techniques, limb morbidity remains high; clinical trials of angiogenic and cell-based therapies are ongoing. Cardiovascular risk reduction in patients with limb ischemia also remains suboptimal and future studies will focus on novel antiplatelet agents.

The acute effects of lower limb intermittent negative pressure on foot macro- and microcirculation in patients with peripheral arterial disease

“…If behavioral changes fail, the next line of therapy is revascularization through endovascular or open surgery [4]. Unfortunately, the current treatment strategies are insufficient for many PAD patients [5–7]. …”

Acute lower limb ischemia secondary to diffuse peritonitis

“…Any sudden impairment of the arterial fl ow to the limb results in ischemia, causing a potential threat to limb viability. 2,9 Population aging increases the prevalence of acute lower limb ischemia. The main etiological factors of acute lower limb ischemia are arterial embolism and thrombosis of an atherosclerotic artery or a bypass graft.…”

The efficacy of extraembryonic stem cells in improving blood flow within animal models of lower limb ischaemia

“…Atherosclerosis is the leading cause of PAD 18. The studies included in this systematic review employed non-atherosclerotic mice which may exhibit faster recovery to angiogenic therapy during ischaemia.…”

“…The generation of HLI in the models employed in studies was mainly through ligation and excision of the FA, which promotes ischaemia suddenly. In patients, CLI generally occurs as a result of a chronic process associated with the build-up of atherosclerotic plaque over many years leading to arterial stenosis and later occlusion 18. Studies comparing acute induction of HLI (by FA excision) with gradual occlusion using ameroid constrictors have found different responses in animals 19 27–29.…”