Chronic limb ischaemia (PAD)

Question 1

Aetiology

Answer 1

Most common cause = Atherosclerosis leading to stenosis of the arteries suppling the limbs
Less common causes = Beurger’s disease and vasculitis

Question 2

Risk factors:

Answer 2

• Male
• Age (old)
• Smoking
• Hypertension
• Hypercholesterolaemia
• Hyperlipidaemia
• Diabetes
• Obesity

Question 3

Symptoms:

Answer 3

Fontaine classification:
Stage I - Asymptomatic
Stage IIA - Claudication when walking a distance greater than 200 m
Stage IIB - Claudication when walking a distance less than 200 m
Stage III - Pain at rest (Mostly in the feet)
Stage IV - Gangrene/necrosis of the limb

Other symptoms include:
Thigh/buttock pain which is relieved by rest

Question 4

Signs:

Answer 4

• Pallor
• Hair loss
• Ulceration
• Slow capillary refill time
• Cold

Question 5

Investigations:

Answer 5

• Ankle-brahcial pressure index
• Beurger’s test
• CT angiography and MRI angiography
• Duplex ultrasound (first line treatment)

Question 6

Treatment:

Answer 6

• Access the risk factors (smoking cessation, control of diabetes, hypertension and lipids/cholesterol, stains therapy, anti-platelet agent)
• Bypass
• Stent
• Revascularisation