Chronic limb ischemia
Pain
| Intermittent claudicating | Rest pain | ||
| Site | Site | Foot and toes | |
| Distal arterial disease | Foot | ||
| Superficial femoral artery | calf | ||
| Aortoiliac disease | Gluteal region Thigh calf | ||
| Onset | insidiously | Onset | |
| Course | Course | ||
| Duration | Duration | ||
| Severity | Claudication distance | Severity | Patients spend the night sitting in chair in attempt to relieve pain |
| Character | Cramp-like | Character | Continuous aching |
| Radiation | Radiation | ||
| Referral | Referral | ||
| Relieving factors | Rest | Relieving factors | Strong analgesics |
| Exacerbating factors | Exercise | Exacerbating factors | Night Elevation of the leg Warmth |
| Relation to other symptoms | Relation to other symptoms | Tissue loss | |
| Cause | Muscular ischemia | Cause | Nerve ischemia |
Tissue changes and loss
Trophic changes (Loss of skin appendages – Loss of subcutaneous fat – Muscle wasting – Bone osteoporotic)
Ulceration or Gangrene
Symptoms of atherosclerosis elsewhere
Brain (TIAs – Stroke)
Heart (Angina pectoris – MI)
Kidney (Hypertension – Haematuria) Intestine (Postprandial angina)
Possible cause
Predisposing factors of atherosclerosis
Cigarette smoking – Hyperlipidaemia – Hypertension – Diabetes mellitus – Obesity – Physical inactivity – Diet high in saturated fats – Hyperhomocysteinaemia – Raised Lp(a) lipoprotein concentrations – Hypercoagulable states
Factors suggesting Burger’s disease
Male – Between 20-40 years – No risk factors of atherosclerosis – Smoking
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