Lower Limb Arterial Disease

Question 1

PATHOLOGY: Intermittent Claudication

Answer 1

• Ischaemic mucle pain (usually due to atherosclerosis)
• Brought on by exercise and relieved by rest
• Most commonly in calf

Question 2

SYMPTOMS: Intermittent Claudication

Answer 2

• Thigh/buttock pain = aorto-iliac disease
• Rest pain in feet when perfusion inadequate for metabolic needs
• Rest pain during night as feet elevated and BP drops

Question 3

AETIOLOGY: Arterial Occlusive Disease

Answer 3

• Usually due to atherosclerosis
• Fixed risk factors*
• Age
• Male
• Diabetes
• FHx hyperlipidaemia

Modifiable factors

• Smoking
• Hyperlipidaemia
• HTN

Question 4

CLINICAL FEATURES: Lower Limb Arterial Disease

Answer 4

Symptoms

• Intermittent claudication
• Rest pain
• Ulcers

Signs - Critical Ischaemia (6 Ps)

• Pain
• Pallor
• Perishing with cold
• Pulselessness
• Parasthesia
• Paralysis

Question 5

INVESTIGATIONS: Lower Limb Arterial Disease

Answer 5

Ankle-brachial pressure index

Culture

• Urinalysis

Bloods

• FBC
• Lipid profile

Imaging

• ECG - for AF
• USS
• Arteriography
• Magnetic resonance angiography

Question 6

What is ABPI?

Answer 6

• Ratio of BP from ankle vs. arm
• Usually BP higher in leg than arm
• IF blood flow impaired leg will drop worse than arm
• >1 = normal
• 0.9-0.6 = claudication
• 0.6 -0.3 = rest pain
• <0.3 = critical ischaemia

Question 7

MANAGEMENT: Lower limb arterial disease

Answer 7

Conservative

• Smoking cessation
• Control diabetes/HTN & hyperlipidaemia
• Aspirin
• Exercise

Operative

• Angioplasty + stent
• Open endarterectomy
• Bypass

Embolus

• Anticoagnulation
• Thrombolysis
• Embolectomy