Lower limb ischaemia

Acute lower limb ischaemia is caused by sudden obstruction of an artery due to an embolus or thrombosis.Chronic lower limb ischaemia is a slowly progressing disease process that is usually caused by an obliterating arterial disease.Acute lower limb ischaemia must be diagnosed and the patient immediately referred for further management. Chronic lower limb ischaemia must be diagnosed and its severity (stage) assessed, as the severity of the condition will determine management approach. Mild ischaemia is asymptomatic, but is suggestive of an increased overall cardiovascular risk. Moderate ischaemia causes intermittent claudication which, as such, is a benign but troublesome complaint. Claudication may be treated conservatively, but if the condition threatens the work or functional capacity of the patient, a referral to a vascular surgeon is indicated. Critical ischaemia manifests itself as pain at rest and may lead to a non-healing chronic leg ulcer and eventually to gangrene. Patients with critical limb ischaemia require urgent referral to a vascular surgeon. If limb ischaemia is complicated by an infection, an emergency referral is indicated. If ischaemia is suspected it should be verified with Doppler ultrasonography and pressure measurements. Examination of the patient, see . Prophylaxis against coronary heart disease and ischaemic cerebrovascular disorders should be provided. This has the greatest impact as regards the patient’s prognosis. The arteries of the lower limbs are never the only site of atherosclerosis in a patient with occlusive arterial disease.