Atkin L, van Orsouw M, Bond E. Peripheral arterial disease. Independent Nurse. 2015; 16:34-37

Avallin T, Muntlin Athlin Å, Björck M, Jangland E. Using communication to manage missed care: a case study applying the Fundamentals of Care framework. J Nurs Manag. 2020; 28:(8)2091-2102

Baubeta Fridh E, Andersson M, Thuresson M Amputation rates, mortality, and pre-operative comorbidities in patients revascularised for intermittent claudication or critical limb ischaemia: a population based study. Eur J Vasc Endovasc Surg. 2017; 54:(4)480-486

Bradbury AW, Adam DJ, Bell J Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: analysis of amputation free and overall survival by treatment received. J Vasc Surg. 2010; 51:18S-31S

Bright T, Burdett T. Smoking cessation and the health promotion role of community nurses. Journal of Community Nursing. 2019; 33:(4)56-60

Cea-Soriano L, Fowkes FGR, Johansson S, Allum AM, García Rodriguez LA. Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK. BMJ Open. 2018; 8:(1)

Focus on: peripheral arterial disease. 2019a. (accessed 7 July 2021)

Coughlin P. Epidemiological risk factors for PAD, risk stratification and risk factor management, 6th edn. In: Loftus I, Hinchliffe R (eds). London: Elsevier; 2019b

de Donato G, Bosiers M, Setacci F 24-month data from the BRAVISSIMO: a large-scale prospective registry on iliac stenting for TASC A & B and TASC C & D lesions. Ann Vasc Surg. 2015; 29:(4)738-50

De Nunzio M, England T. Pathogenesis of atherosclerosis and methods of arterial and venous assessment, 3rd edn. In: England T, Nasim A (eds). Oxford: Wiley; 2015

Donnelly R. Secondary prevention and antiplatelet therapy in peripheral arterial disease, 3rd edn. In: England T, Nasim A (eds). Oxford: Wiley; 2015

Eastern Cooperative Oncology Group, American College of Radiology Imaging Network Cancer Research Group. ECOG performance status. 2020. (accessed 7 July 2021)

Fix G, VanDeusen Lukas C, Bolton R Patient-centred care is a way of doing things: how healthcare employees conceptualize patient-centred care. Health Expectations. 2017; 21:(1)300-307

Gimbrone MA, García-Cardeña G. Endothelial cell dysfunction and the pathobiology of atherosclerosis. Circ Res. 2016; 118:(4)620-36

Golledge J, Moxon JV, Rowbotham S Risk of major amputation in patients with intermittent claudication undergoing early revascularization. Br J Surg. 2018; 105:(6)699-708

Gould BE, Dyer RM. Pathophysiology for the health professions, 6th edn. St Louis (MO): Elsevier; 2018

Grundy SM. Metabolic syndrome update. Trends Cardiovasc Med. 2016; 26:(4)364-373

Hall S. Care of patients requiring vascular surgery, 3rd edn. In: Pudner R (ed). London: Elsevier; 2010

Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol. 2014; 31:(4)378-88

Hiatt WR, Armstrong EJ, Larson CJ, Brass EP. Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease. Circ Res. 2015; 116:(9)1527-39

Kitson AL. The fundamentals of care framework as a point-of-care nursing theory. Nurs Res. 2018; 67:(2)99-107

Krishna SM, Moxon JV, Golledge J. A review of the pathophysiology and potential biomarkers for peripheral artery disease. Int J Mol Sci. 2015; 16:(5)11294-11322

Meecham L, Popplewell M, Bate G, Patel S, Bradbury AW. Contemporary (2009-2014) clinical outcomes after femoropopliteal bypass surgery for chronic limb threatening ischemia are inferior to those reported in the UK Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL) trial (1999-2004). J Vasc Surg. 2019; 69:(6)1840-1847

Mitrugno A, Tormoen GW, Kuhn P, McCarty OJ. The prothrombotic activity of cancer cells in the circulation. Blood Rev. 2016; 30:(1)11-19

Murphy TP, Cutlip DE, Regensteiner JG Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol. 2015; 65:(10)999-1009

Mylankal K, Fitridge R. Assessment of chronic lower limb ischaemia, 6th edn. In: Loftus I, Hinchliffe R (eds). London: Elsevier; 2019

Nair M. The vascular system and associated disorders, 3rd edn. In: Peate I. Oxford: John Wiley and Sons; 2018

National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. Clinical guideline CG147. 2020. (accessed 7 July 2021)

Nickinson A, Bown MJ. Acute and chronic limb ischaemia. Surgery (Oxford). 2019; 37:(2)93-101

NHS England/NHS Improvement. The NHS long term plan. 2019. (accessed 7 July 2021)

Nursing and Midwifery Council. The code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 7 July 2021)

O'Neill S, O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015; 16:(1)1-12

Olinic DM, Spinu M, Olinic M Epidemiology of peripheral artery disease in Europe: VAS educational paper. Int Angiol. 2018; 37:(4)327-334

Paquissi FC. The role of inflammation in cardiovascular diseases: the predictive value of neutrophil-lymphocyte ratio as a marker in peripheral arterial disease. Ther Clin Risk Manag. 2016; 12:851-860

Sakakura K, Nakano M, Otsuka F, Ladich E, Kolodgie FD, Virmani R. Pathophysiology of atherosclerosis plaque progression. Heart Lung Circ. 2013; 22:(6)399-411

Samson SL, Garber AJ. Metabolic syndrome. Endocrinol Metab Clin North Am. 2014; 43:(1)1-23

Turning the tide on tobacco: Smoking in England hits a new low. Public Health Matters (blog). 2018. (accessed 7 July 2021)

Song P, Rudan D, Zhu Y Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7:(8)e1020-e1030

Telford R. Anaesthesia for vascular surgery on the extremities. Anaesthesia and Intensive Care Medicine. 2019; 20:(5)272-276

Varcoe RL. Intervention for chronic lower limb ischaemia, 6th edn. In: Loftus I, Hinchliffe R (eds). London: Elsevier; 2019

World Health Organization. Obesity and overweight. Key facts. 2021. (accessed 7 July 2021)

Yang SL, Zhu LY, Han R, Sun LL, Li JX, Dou JT. Pathophysiology of peripheral arterial disease in diabetes mellitus. J Diabetes. 2017; 9:(2)133-140

Chronic limb ischaemia: case study and clinical literature review

22 July 2021
15 min read
Volume 30 · Issue 14


This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.

Chronic limb ischaemia is the result of peripheral artery disease (PAD). This article will discuss the epidemiology, aetiology and pathophysiology of the disease, as well as critically evaluating the methods of assessment and surgical treatment used. A case study will be presented. Patient details have been anonymised to protect confidentiality, in line with the Nursing and Midwifery Council Code (2018).

PAD affects more than 200 million people worldwide (Yang et al, 2017) and is the third most common clinical presentation of atherosclerosis after coronary artery disease (CAD) and stroke (Song et al, 2019). Previously an ailment of more affluent nations, the disease is now becoming more common in poorer countries (Coughlin, 2019a). The upward trend in international incidence has been attributed to a number of causative factors, with arguably the most important being a significant increase in life expectancy (Baubeta Fridh et al, 2017). This is a reasonable theory when considering there is a proven link between ageing and PAD presentation, with various studies identifying a sharp increase in prevalence from 3% to 10% among the general populace to 15% to 20% when focusing on those aged more than 70 years (Coughlin, 2019a).

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