Critical Limb Ischaemia

Management and Treatment of Critical Limb Ischaemia

■ Due to the complex poly-vasculopathy associated with PAD, a holistic approach to management is needed7

■ Management with early-stage PAD or advanced stage CLTI should focus on pain management, promotion of wound healing, reduction of cardiovascular risk factors, and optimization of glycemic control

■ Pain management is fundamental to improve quality of life

■ Common modalities for treating pain include peripheral revascularization; however, for those unable to undergo revascularization acetaminophen and nonsteroidal antiinflammatory drugs are often first line

■ Scheduled dosing of analgesics is superior to an as-needed regimen for sustained relief

■ Some pain associated with PAD may be neuropathic, prompting a careful differential in evaluating pain as the use of neuropathic pain agents may provide the best control

■ Cardiovascular risk factors should be managed with a multifaceted approach

■ Smoking cessation should begin early and routinely addressed as it has been shown to reduce mortality and improve amputation-free survival10

■ Uncontrolled dyslipidemia contributes to the development and progression of PAD and can be treated with statin therapy to reduce cardiovascular events11

■ Hypertension should be controlled according to guidelines

■ Hyperglycemia is a risk factor of PAD and attention to glycemic control is required. Glycemic control involves both medication management and subsequent monitoring of HbA1c, which has been shown to be a predictor of major amputation12,13

■ Antiplatelet therapy with aspirin or clopidogrel is indicated for secondary prevention in patients with PAD