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Diagnostic Approach to Chronic Critical Limb Ischemia

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Critical Limb Ischemia

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Abstract

Critical limb ischemia (CLI), if left untreated, is associated with a high risk of limb loss (Hirsch et al., Circulation 113(11):e463–654, 2006; Abou-Zamzam et al., Ann Vasc Surg 21(4):458–463, 2007; Anderson et al., Circulation 127(13):1425–1443, 2013). Before revascularization can be performed, a thorough but efficient diagnostic approach is warranted. The diagnostic process begins with an initial clinical evaluation to assess for the presence of peripheral artery disease (PAD). Any underlying comorbidities the patient has must be identified as they will influence decisions regarding the diagnostic evaluation. CLI is manifested by rest pain and/or tissue loss of the lower extremity but is also an indicator of atherosclerotic disease in other vascular beds that increases the patient’s risk of cardiovascular events (Criqui et al., N Engl J Med 326:381–386, 1992; Caro et al., BMC Cardiovasc Disord 5:14, 2005; Fowkes et al., JAMA 300(2):197–208, 2008; Resnick et al., Circulation 109(6):733–739, 2004; Suominen et al., Eur J Vasc Endovasc Surg 39(3):316–322, 2010); this along with other comorbidities will determine the patient’s risk of revascularization. The process then proceeds to diagnostic studies to confirm the presence of PAD, localize the lesions that need treatment, and finally plan a revascularization procedure if indicated (Hirsch et al., Circulation 113(11):e463–654, 2006). With the recent explosion of treatment modalities for PAD, there has been an equal development of imaging modalities available to delineate the patient’s vascular anatomy prior to revascularization (Harris et al., AJR Am J Roentgenol 197(2):W314–W317, 2011; de Vos et al., J Vasc Surg 59(5):1315–1322 e1, 2014). Noninvasive vascular lab studies are used to determine the hemodynamic significance of the patient’s vascular lesions (Anderson et al., Circulation 127(13):1425–1443, 2013). Anatomic imaging by arterial duplex ultrasound, computed tomography angiography (CTA), magnetic resonance angiography (MRA), or catheter-based digital subtraction angiography (DSA) can then be used to plan a revascularization procedure (Anderson et al., Circulation 127(13):1425–1443, 2013; de Vos et al., J Vasc Surg 59(5):1315–1322 e1, 2014; Grassbaugh, J Vasc Surg 37(6):1186–1190, 2003; Collins et al., BMJ 334(7606):1257, 2007; Lowery et al., Ann Vasc Surg 21(4):443–451, 2007). The best imaging study to obtain depends on the patient’s underlying comorbidities, distribution of disease, and institution-specific imaging capabilities (first figure of this chapter).

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite #650, Chicago, IL, 60611, USA

    Tadaki M. Tomita MD

  2. Department of Surgery, University of North Corolina, Chapel Hill, NC, USA

    Melina R. Kibbe MD

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  1. Tadaki M. Tomita MD
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  2. Melina R. Kibbe MD
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Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    Robert S. Dieter

  2. Northwestern Medicine Central DuPage Hospital, Glen Ellyn, Illinois, USA

    Raymond A. Dieter, Jr

  3. The University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

  4. West Virginia University, Charleston, West Virginia, USA

    Aravinda Nanjundappa

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Tomita, T.M., Kibbe, M.R. (2017). Diagnostic Approach to Chronic Critical Limb Ischemia. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_15

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  • DOI: https://doi.org/10.1007/978-3-319-31991-9_15

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