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Chronic Limb Ischaemia Guide

What is chronic limb ischaemia?

Chronic ischaemia is the medical term referring to a deficiency in blood to an area of tissue that has persisted for a long period of time causing symptoms of pain with activity. The most common location for chronic limb ischaemia is in the legs, but sometimes it can occur in the arms.

Treatment Options

The goal of treatment is to reopen the blocked area and to improve blood flow to the areas affected by the chronic ischaemia. There are various treatment options. Your doctor will suggest the appropriate choice.

Medical Treatment

Medication can be used alone or in conjunction with any of the other treatments. Medication does not eliminate the narrowing of the arteries, but can improve blood flow and/or prevent blood clots. The most important treatment is to stop smoking. Taking regular exercise and gradually increasing the amount of exercise may relieve the symptoms.

Balloon angioplasty and/or stenting

The operation can be done while you are asleep or awake, the doctor will discuss this with you. A catheter mounted balloon is placed inside the artery where the lesion is located. It is inflated to press the plaque against the artery wall and is then removed. This can be followed up by expanding a stent into the vessel wall. This stent will remain in place permanently to keep the artery open

Endarterectomy

The operation can be done while you are asleep or awake, the doctor will discuss this with you. An endarterectomy is an operation used to remove the fatty build up (plaque) in the arteries supplying blood to your legs. The surgeon makes a cut along the artery and removes the plaque from the wall of the artery. The cut in the artery is sewn up and a small plastic drainage tube is inserted.

Bypass surgery

The operation is done while you are asleep. The goal of the surgeon is to bypass the blocked area in any part of the arteries supplying blood to your legs with an artificial graft. This will restore the blood supply to your legs.

Before the operation

The following tests would have been performed:

  • Chest x-ray
  • Blood tests
  • Electrocardiogram (ECG)
  • Urine test
  • You will be seen by the anesthetist

Medications

You should continue taking your normal medications. Please consult your doctor for advice if you are taking WARFARIN or HORMONE REPLACEMENT.

Belongings and valuables

Please bring your own toiletries and pajamas. Leave any valuables at home.

The day before the procedure

You will be admitted to the ward for bowel preparation. This will involve drinking fluids only and you will also be given an enema. Nothing is to be taken orally from 10 pm at night. You will also be given lung physiotherapy.

Post-Operative Plan

ANGIOPLASTY AND/OR STENTING
You will spend one night in the High Care Unit where the nursing staff will check the site where the catheter was inserted as well as the pulses in your feet and arms. You will urinate often to get rid of the x-ray dye that was injected into your arteries. You will be instructed to drink more fluids to get rid of the dye more easily. Before you leave the hospital, your doctor will instruct you about the pharmaceutical therapy and activity levels following the procedure. It is very important to regularly check the condition of your arteries and your doctor will schedule those check-ups with you.

ENDARTERECTOMY
You will spend one night in the Intensive Care Unit (ICU) before returning to the ward. The nurse looking after you will:
• Connect you to a machine that will monitor your heart rate and rhythm
• Check your blood pressure often
• Feel for pulses in the legs and feet
• Check your arm and leg movements
• Check that the tube in your arm is working

SURGERY
You will be admitted to ICU. You might have a tube in your mouth connecting you to a ventilator and a tube in your nose for drainage of your stomach, depending on where the bypass was done. Over the next few days these tubes will be removed. You will be connected to a machine that will monitor your heart rate and rhythm and your blood pressure. You will have a catheter (a tube) in your bladder to measure your urine output. You will have a drip or epidural catheter that contains medication for pain.

You will receive daily physiotherapy.

DIET AND FLUIDS
You will not be able to eat or drink anything until your doctor gives you permission to after bypass surgery. You may eat and drink as you like after the endarterectomy and angioplasty and/or stenting.

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