Peripheral Vascular Disease

Poor circulation in the legs is a common problem present in over 8% of patients >70 years of age. It can be found in younger people particularly in those with diabetes or who are current or past smokers. There are some individuals who have circulation problems in the leg and have no obvious risk factors. These individuals probably have a genetic predisposition.

Poor circulation in the legs or Peripheral vascular disease can manifest itself in 2 ways:

1. Claudication

2. Critical limb ischaemia

Claudication

Leg pains on walking, usually in the calf muscles but can be thigh and buttock. These pains are relieved by stopping for a few minutes. The indiviudal can usually walk again for a similar distance before having to stop again. This is a life-style limiting condition that in 70-80% of patients will remain stable or even improve without treatment but simply conservative and medical means.

Differential Diagnoses: Other conditions that mimic circulation problems in legs):

Nerve route compression
Arthropathy
Compartmental syndrome
Venous claudication

Critical limb ischaemia

This is a serious limb threatening condition with pain in legs at rest and/or leg ulceration. Often the indiviual may have suffered symptoms suggestive of claudication (see above) for a number of months or years and quite suddenly the symptoms worsen. The same pain that was experienced on walking now starts to come on at night time and when resting. The symptoms may be temporarily improved by hanging the leg over the side of the bed or by simply standing up. As the situation worsens, ulcers or gangrene may appear. If this condition does not improve, then the leg is threatened and may ultimately require amputation.

Assessment of peripheral vascular disease

At your initial clinic visit, a thorough history of your symptoms will be taken. The duration of your symtoms, the severity and how much it limits your activities. Risk factors will be assessed such as smoking, hypertension, lipids/ cholesterol status, family history. You will be asked specific questions to assess other concomittant artery disaese (eg heart problems, stroke, mini strokes).

Examination will include a full assessment of your leg pulses from the groin to the foot and your abdomen (tummy) will also be examined for abdominal aortic aneurysm (AAA). A hand held Doppler machine will be used to assess the blood flow in your legs and compared to that in your arm. The ratio of the blood pressure in your leg and arm will be quantified (ABPI). This gives an indication to the severity of your arterial disease in your leg. An Ankle Brachial Pressure Index (ABPI) of 0.9 - 1.2 is normal.

If your symptoms warrant further evaluation, an arterial duplex scan will be arranged. This ultrasound investigation is non-invasive and gives plenty of information about where the blockage in your leg is situated and it also helps determine whether it will or will not be suitable for angioplasty(balloon stretch)/ stent or traditional surgical bypass.

For information on angioplasty and/ or stent, please click here

For information on surgical bypass, please click here

Presentations

Claudication to critical ischaemia in 5 steps (Systemic problem of PVD including REACH registry)

Peripheral vascular disease