Acute Limb Ischaemia (ALI)

Answer Explanation:

• The correct answer is ‘Rest pain’. This is because rest pain is one of the cardinal features of critical limb ischaemia. It is a severe pain that occurs even when the patient is at rest, typically in the foot or toes and often at night. It is caused by insufficient blood supply to the tissues.

Overview of Critical Limb Ischaemia:

Critical limb ischaemia (CLI) is a severe obstruction of the arteries which drastically reduces blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers or sores.

Signs and Symptoms:

• Rest pain: Severe pain in the limb, often in the foot or toes, which occurs even when at rest.
• Non-healing wounds: Wounds or ulcers on the feet or toes that do not heal, or heal very slowly.
• Gangrene: In severe cases, lack of blood flow can cause tissue death (gangrene).

Diagnostic Criteria:

• Ankle-brachial index (ABI): An ABI of less than 0.4 is indicative of CLI.
• Toe pressure: A toe pressure of less than 30 mm Hg is also indicative of CLI.
• Imaging: Angiography, Doppler ultrasound, CT angiography or MR angiography may be used to confirm the diagnosis and plan treatment.

Treatment:

Treatment aims to improve blood flow to the affected limb, relieve pain, heal ulcers, prevent limb loss, improve quality of life and prolong survival. This may involve:

• Medication: Antiplatelet and anticoagulant drugs, pain relief, and drugs to control risk factors such as hypertension and hyperlipidaemia.
• Revascularisation: This may be done by angioplasty (with or without stenting) or bypass surgery.
• Amputation: In severe cases where revascularisation is not possible or has failed, amputation of the affected limb may be necessary.

Answer Explanation:

• The correct answer is limb amputation. In cases of critical limb ischaemia, where the blood supply to the limb is severely reduced, limb amputation may be necessary if other treatments fail to improve blood flow or if the limb has become gangrenous. This is a last resort treatment option when all other options have been exhausted or are not suitable.
• Insulin is used in the management of diabetes, which can be a risk factor for peripheral artery disease and subsequently critical limb ischaemia, but it is not a direct treatment for the condition.
• Amlodipine is a calcium channel blocker used to treat high blood pressure and angina, but it is not a specific treatment for critical limb ischaemia.
• An inferior vena cava filter is used to prevent pulmonary embolism by catching blood clots before they reach the lungs. It is not a treatment for critical limb ischaemia.
• Compression stockings are used to improve circulation in the legs, often in the management of conditions like varicose veins or to prevent deep vein thrombosis. They are not a treatment for critical limb ischaemia.

Overview of Critical Limb Ischaemia:

• Critical limb ischaemia is a severe obstruction of the arteries which significantly reduces blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers or sores.
• It is often caused by peripheral artery disease, where fatty deposits build up in the arteries and reduce blood flow. Other causes can include blood clots or embolism.
• Common symptoms include pain at rest, non-healing wounds, gangrene and a significant reduction in mobility.
• Management options include medication, angioplasty, stent placement, bypass surgery, thrombolytic therapy and, in severe cases, amputation.
• Risk factors include smoking, diabetes, obesity, high blood pressure and high cholesterol.