Ortho-trauma » Infections & Inflammations

Lower limb ischaemia

The stages indicative of the severity of Peripheral arterial disease in the lower limb are

1. intermittent claudication ie pain, usually in the calf, precipitated by walking;
2. pain at rest;
3. arterial ulceration of the leg and foot and
4. gangrene of the leg and foot.

Latter three indicate critical limb ischaemia with a high risk of amputation and death. Ischemic rest pain commonly presents as a burning pain usually in the foot, aggravates with foot elevated at night and relieved by lowering the leg. Chronic lower limb ischaemia manifests with pain even at rest and non-healing wounds. Critical ischaemia manifests with gangrene. Management of limb ischeamia can be either conservative therapy, revascularization or amputation. Gangrene and rapidly enlarging wounds or continuous ischemic pain at rest signify a threat to the limb and suggest a serious consideration for revascularization. Diabetics usually present with distal disease, which is less amenable to bypass grafting. Revascularization is more cost-effective compared with amputation. Limb preservation should be the goal in most patients with critical limb ischemia.

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