Ischemia also has grades 0-3. Grade 0 is ABI (ankle-brachial index) > 0.8, with ankle systolic pressure >100mmHg, toe pressure(TP) >60. Grade 1 is ABI 0.6-0.79, ankle systolic pressure 70-100mmHg, TP 40-59. Grade 2 is ABI 0.4-0.59, ankle systolic pressure 50-70mmHg, TP 30-39. Grade 3 is ABI <0.39, ankle systolic pressure <50mmHg, TP <30.
The third category is foot infection. Grade 0 is no symptoms or signs of infection. Grade 1- infection is present and at least 2 of the following are present: local swelling, erythema >0.5 to <cm around ulcer, local tenderness or pain, local warmth, or purulent discharge. Other causes of an inflammatory response of the skin have been excluded(gout/fracture). Grade 2 is a local infection is present as defined for Grade 1, but extends > 2cm around ulcer, or involves structure deeper than the skin and subcutaneous tissues(eg. Abscess, osteomyelitis, septic arthritis, fasciitis). No clinical signs of systemic inflammatory response. Grade 3 is a local infection that is present as defined for Grade 2, but clinical signs of systemic inflammatory response are present as manifested by 2 or more of the following: temperature >38°C or <36°C; heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO2 <32 mmHg; white blood cell count >12,000 or <4000 (cu/mm) or >10 percent immature band forms present. Patient is grade 2 for foot infection, in which he had a local infection on his foot that was 2cm by 2cm, and involves structure deeper than the skin and subcutaneous tissues.
Based on these considerations, the patient with PAD can be placed into one of four amputation risk categories (very low, low, moderate, high). Patient had to amputate his 2nd and 3rd L toes.
(Mills, 2014)
Femoropopliteal bypass is indicated when arteriography reveals that the superficial femoral artery or proximal popliteal artery is occluded and that the patient popliteal artery has luminal continuity with any of its three terminal branches. With a popliteal occlusion, a bypass to an isolated segment of popliteal artery is usually effective if the segment is greater than 7 cm in length. If the isolated popliteal segment is less than 7 cm or there is severe gangrene of the foot, a sequential bypass to the popliteal and then to a more distal vessel should be considered. Patient had a fem-pop bypass on 2/18 because his angiography showed occluded left superficial femoral artery distal reconstitution of the popliteal artery through collateral vessels consistent w/ chronic occlusion. Two vessel runoff in the calf.