![]() ![]() Recently, the Society for Vascular Surgery came out with a classification system based on "wound, ischemia and foot Infection" (WIfI). Moderate to severe PAD classified by Fontaine's stages III to IV or Rutherford's categories 4 to 5, presents limb threat (risk of limb loss) in the form of critical limb ischemia. Grade IV, Category 6: major tissue loss severe ischemic ulcers or frank gangrene.Grade III, Category 5: minor tissue loss ischemic ulceration not exceeding ulcer of the digits of the foot.Grade I, Category 3: severe claudication.Grade I, Category 2: moderate claudication.This classification system consists of four grades and seven categories (categories 0–6): The Rutherford classification was created by the Society for Vascular Surgery and International Society of Cardiovascular Surgery, introduced in 1986 and revised in 1997 (and known as the Rutherford classification after the lead author, Robert B. Stage IV: ulcers or gangrene of the limb.Stage IIb: intermittent claudication after walking a distance of less than 200 meters.Stage IIa: intermittent claudication after walking a distance of more than 200 meters.The Fontaine stages, were introduced by René Fontaine in 1954 to define severity of chronic limb ischemia: The two most commonly used methods to classify peripheral artery disease are the Fontaine and the Rutherford systems of classification. Classification Gangrene of three toes resulting from peripheral artery disease The advantages of MRA include its safety and ability to provide high-resolution, three-dimensional imaging of the entire abdomen, pelvis and lower extremities in one sitting. ![]() Magnetic resonance angiography (MRA) is a noninvasive diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of blood vessels inside the body. An important distinction between the two is that, unlike invasive angiography, assessment of the arterial system with CT does not allow for vascular intervention As such, CT may be considered as an alternative to invasive angiography. Studies have shown the sensitivity and specificity of CT in identifying lesions with >50% stenosis as 95% and 96% respectively. Modern computerized tomography (CT) scanners provide direct imaging of the arterial system. Contrast angiography is the most readily available and widely used imaging technique. Any blood flow-limiting blockage found in the X-ray can be identified and treated by procedures including atherectomy, angioplasty, or stenting. While injecting a radio-dense contrast agent, an X-ray is taken. Other imaging can be performed by angiography, where a catheter is inserted into the common femoral artery and selectively guided to the artery in question. If ABIs are abnormal, the next step is generally a lower limb Doppler ultrasound to look at the site of obstruction and extent of atherosclerosis. A decrease in ABI of 15%–20% would be diagnostic of PAD. The patient is then asked to exercise (usually patients are made to walk on a treadmill at a constant speed) until claudication pain occurs (for a maximum of 5 minutes), after which the ankle pressure is again measured. A baseline ABI is obtained prior to exercise. ![]() In individuals with suspected PAD with normal ABIs can undergo exercise testing of ABI. Individuals with noncompressible arteries have an increased risk of cardiovascular mortality within a two-year period. Abnormally high ABIs (>1.40) are usually considered false negatives and thus, such results merit further investigation and higher-level studies. If an ABI >1.40 is calculated, this could indicate vessel wall stiffness caused by calcification, which can occur in people with uncontrolled diabetes. Īnkle-brachial index 1.40 indicate noncompressible arteries. Leg pain when walking that resolves with rest, skin ulcers, bluish skin, cold skin Ĭigarette smoking, diabetes, high blood pressure, high blood cholesterol. Interventional radiology, vascular surgery Peripheral vascular disease (PVD), peripheral artery occlusive disease, peripheral obliterative arteriopathyĪn arterial insufficiency ulcer in a person with severe peripheral artery disease Medical condition Peripheral artery disease ![]()
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