Intermittent claudication Flashcards
what is intermittent claudication?
most common clinical symptom associated with peripheral arterial disease
occurs when diminished circulation leads to pain in lower limbs on exertion, the pain is relieved by rest
what is peripheral arterial disease?
narrowing/occlusion of peripheral arteries affecting blood supply to lower limbs
how can chronic leg ischaemia present?
intermittent claudication
critical limb ischaemia
chronic limb-threatening ischaemia
acute limb ischaemia
causes of intermittent claudication
atherosclerosis inflammatory disorders - vasculitis thromboembolism Buerger's disease trauma physiological entrapment syndromes cystic adventitial disease acute limb ischaemia cardiac embolisation aortic dissection graft thrombosis thrombosis. of popliteal aneurysm hypercoagulable states iatrogenic complications of vascular interventions
what is acute limb ischaemia?
sudden reduction in arterial perfusion of limb due to thrombosis within diseased artery when atherosclerotic plaque ruptures
risk factors for intermittent claudication
smoking diabetes mellitus advanced age hypertension hypercholesterolaemia athersclerotic disease chronic kidney disease high serum homocysteine
complications of intermittent leg claudication
impaired quality of life - limited mobility psychosocial consequences - depression tissue loss - ulceration and gangrene increased amputation risk procedural complications high risk of vascular complications compartment syndrome reperfusion injury
vascular complications associated with intermittent leg claudication
MI stroke vascular dementia renovascular disease mesenteric disease
what is a thrombus?
blood clot in a vein
how is intermittent leg claudication diagnosed?
history
assessment of symptoms
risk factors
examination
ankle brachial pressure index measured using doppler
systolic BP
ABPI ratio of <0.9 present in peripheral artery disease but >0.9 doesn’t exclude it
raised ABPI (1.4+) suggests peripheral artery disease, especially in those with diabetes
examination for intermittent leg claudication
ulceration temperature differences muscle atrophy skin changes check popliteal, femoral and foot pulses capillary refill time general CVS examination
what is an embolus?
anything that moves through blood vessels until it reaches one that it is too large to pass through
the flow is stopped
often a small piece of blood clot
small piece of blood clot moving through blood vessels
thromboembolus
what are the clinical features of intermittent leg claudication?
cramping pain in the leg after walking a predictable distance
relieved by rest
reproduced by walking the same distance
symptoms present in the distal extremity before proximal area
differential diagnoses of intermittent leg claudication
nerve root compression hip arthritis spinal stenosis foot and ankle arthritis chronic compartment syndrome venous claudication symptomatic Baker's cyst
