Chronic Leg Ischaemia

Question 1

What is chronic leg ischaemia?

Answer 1

Peripheral artery disease occurs due to atherosclerosis causing stenosis of arteries. Co-existing cerebral/coronary artery disease. Intermittent claudication.

Question 2

What are the symptoms of chronic leg ischaemia?

Answer 2

1. Claudication - cramping pain after walking, relieved by rest.
2. Ulceration, gangrene
3. Burning pain at night relived by hanging legs over bed.

Question 3

What are the signs in chronic leg ischaemia?

Answer 3

1. Absent femoral, popliteal or foot pulses.

2. Cold, white legs.

Question 4

How is suspected chronic leg ischaemia investigated?

Answer 4

1. Exclude DM, arteritis (ESR)
2. ABPI
3. Imaging - duplex USS, MR/CT angiography

Question 5

What are the normal, PAD, and critical results of ABPI?

Answer 5

1. Normal - 1-1.2
2. PAD - 0.5-0.9
3. Critical - <0.5

Question 6

What is the management for chronic leg ischaemia?

Answer 6

1. Risk factor modification - smoking cessation, treat HTN and dyslipidaemia
2. Antiplatelet treatment - atorvastatin 80mg and clopidogrel 75mg
3. Surgical resection, percutaneous angioplasty, bypass graft reconstruction.