claudication of the lower limb Flashcards
what is peripheral arterial disease? PAD
a chronic atherothrombotic occlusive disorder of the peripheral circulation that predominantly affects the large, medium-sized and small arteries of the lower limbs
risk factors for PAD
age over 55 years smoking, diabetes mellitus hypercholesterolaemia hypertension obesity sedentary lifestyle
how do patients with PAD present
intermittent claudication IC
critical limb ischaemia CLI
patients with CLI present with these signs
ankle pressures < 50mmhg
toe pressures < 30mmhg
ischaemic pain at rest
tissue necrosis - gangrene or ulcer
3 clinical categories for PAD
aorto iliac disease
femoral popliteal disease
tibio peroneal disease
what is intermittent claudication
IC is defined as an exertional symptom affecting muscles of the lower limb secondary to PAD
how is claudication classified
intermitten claudication associated with PAD
spinal claudication
venous claudication
atypical claudication
what do patients complain of with PAD
pain lameness discomfort cramping stiffness ipsilateral calf muscles stiff rarely thigh muscles and buttocks
what is leriche syndrome
aorto iliac disease
impotence
buttock claudication
how do patients with IC present vs spinal claudication, venous claudication
IC: claudication on walking esp on inclines, relief from 3-5 minutes of rest standing
spinal claudication: often associated with spinal stenosis, Difficulty getting up; long claudication distances; improvement with walking on incline, relief from rest lying down or sitting for 20-30min
venous claudication: associated with venous reflux and occlusive disease
risk factors for IC
smoking risk increased 4x
diabetic patients risk 2x increased
how do you predict progressive IC
ankle brachial index = ratio of ankle pressure/ brachial blood pressure = < 0.50
ddx of painful lower limb
Spinal stenosis
Sciatica
Lumbar spondylosis
Arthropathy (osteo, rheumatoid, gout, etc.)
Varicose veins
Deep-vein thrombosis/post-phlebitic syndrome
Peripheral neuropathy (diabetic, alcohol- associated, etc.)
Chronic regional pain syndromes
Chronic exertional syndromes (anterior compartment syndrome, etc.)
Restless leg syndrome
Infections (cellulitis, tinea pedis, etc.)
Other vascular pathologies (popliteal aneurysms, iliac artery syndrome of the cyclist, etc.)
what is the baseline evaluation of the claudicant
Full blood count
Fasting lipid profile
Fasting blood glucose/HbA1C (glycosylated haemoglobin)
Serum urea, creatinine and electrolytes
Blood clotting profile

Additional tests to be based on clinical suspicion, e.g. a thrombophilia profile in young patients with PAD
furhter investigations for PAD
lower limb exercise doppler test duplex doppler arteriography multi detector computed tomography magnetic resonance angiography peripheral angiography
