Clinical meaning
Advanced peripheral vascular disease represents diffuse atherosclerosis with significant stenosis or occlusion of lower extremity arteries. Critical limb ischemia (CLI) occurs when rest blood flow cannot meet baseline metabolic needs, leading to ischemic rest pain, non-healing wounds, and tissue necrosis requiring revascularization to prevent amputation.
Diagnosis & workup
Diagnostics & workup: - Order ABI with exercise testing - Order CT angiography or MR angiography for anatomic assessment - Order segmental pressures and pulse volume recordings - Order wound assessment and tissue oxygen measurements (TcPO2) - Order toe pressures for diabetic patients (falsely elevated ABI)
Risk factors: - Smoking (strongest risk factor) - Diabetes mellitus (accelerates disease) - Chronic kidney disease (calcific arteriopathy) - Advanced age - Hyperlipidemia - Prior failed revascularization - Multilevel arterial disease