Of these amputations, 85% are considered preventable.7 Clinical Presentation and Diagnosis The clinical presentation of critical limb ischemia may vary from no symptoms to intermittent claudication,
atypical leg pain, rest pain, ischemic ulcers, or gangrene. The ABI is a simple test that can be conducted in the office and typically confirm the presence Inhibitors,research,lifescience,medical of disease. It is calculated by dividing the ankle pressure by the highest brachial pressure. An ABI <0.9 is abnormal and indicates critical limb ischemia. An ABI between 0.7 and 0.9 is considered mild disease, between 0.3 and 0.69 is moderate disease, and less than 0.3 is severe disease. There are many classifications for claudication and limb Inhibitors,research,lifescience,medical ischemia, but the most utilized is the Rutherford-Becker classification. Rutherford Grade I indicates essentially asymptomatic patients or symptoms during a very high level of activity; Rutherford Grade II is symptoms during a moderate level of activity; and Rutherford Grade III is symptoms during a low level of activity. Claudicants are considered to fall within Rutherford Grade I-III. Rutherford Grade IV is symptoms during rest and is termed “Rest
Pain.” Rutherford Grade V is forefoot ulceration, and Rutherford Grade VI is ulceration with tissue necrosis. Rutherford Grade V Inhibitors,research,lifescience,medical and VI are termed “Tissue Loss.” Claudication is the typical symptomatic expression of critical limb ischemia. However, Inhibitors,research,lifescience,medical asymptomatic disease may occur in up to 50% of these patients. Of the 460 patients with critical limb ischemia in the Walking and Leg Circulation Study,10 19.8% had no exertional leg pain, 28.5% had atypical leg pain, 32.6% had classic intermittent claudication, and 19.1% had pain at rest. The results of these and other studies indicate that more patients with critical limb ischemia are asymptomatic
or have atypical leg symptoms than have classic intermittent Inhibitors,research,lifescience,medical claudication. The presence of critical limb ischemia has two major consequences. The first is a decrease in overall well-being and quality of life due to reduced blood flow and atypical leg pain. This often leads to patients becoming sedentary due to pain and discomfort. They may develop depression. The second consequence is markedly increased cardiovascular morbidity (myocardial infarction and stroke) and mortality (cardiovascular and all-cause). Risk Factors Critical first limb ischemia is most often diagnosed by an ABI ≤ 0.9. A low ABI is an independent predictor of increased mortality. In the Framingham Study, mortality in patients with intermittent claudication was 2–3 times higher than in age- and sex-matched control patients, with 75% of critical limb ischemia patients dying from cardiovascular events. In a Selleck GDC-973 15-year review of patients with claudication, over 66% of mortality was attributable to CVD. In a 10-year prospective study by Criqui et al.