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Chronic Ischemia

Oct 28, 20242 min read

Chronic Limb ischemia

Decreased limb perfusion for >2 weeks Senile atherosclerosis is common in both lower and upper limb

Etiology Lower limb ischemia:

  • Atherosclerosis
  • Thrombangitis obliterans

Upper Limb Ischemia:

  • Aorto-arteritis (Takayasu arteritis)
  • Raynaud’s disease
  • Thoracic outlet obstruction
  • Other rarer causes
    • mixed cryoglobulinemia,
    • nodular periarteritis,
    • dermatomyositis,
    • systemic scleroderma

Risk factors

  • Old Age (>70 yrs)
  • Male gender
  • Diabetes
  • Smoking
  • Hypertension
  • Hypercholesterolemia
  • Hypertriglyceridemia
  • Hyperhomocysteinemia
  • Sedentary Lifestyle
  • Family History
  • Fatty diet
  • Drugs (beta blockers, OCP)

Clinical presentation

  • Pain (most common symptom) – on walking (Intermittent claudication / Rest pain
  • Paraesthesia
  • Pallor
  • Diminished or absent pulse
  • Cold limb (Poikilothermia)
  • Diminished hair, brittle nail, thinning & shining of skin
  • Small Ulcer
  • Gangrene

Characteristic features of Claudication pain

    1. Always precipitated by activity
    1. Relieved by taking rest
    1. It is a cramp like pain felt over the muscles
    1. Is always reproducible.

Claudication Distance

  • It is the distance travelled by a person with Peripheral Occlusive Vascular Disease before the onset of Pain.
  • It is thought to be due to the accumulation of Substance P and Lactic acid.

Factors Affecting Claudication Distance Claudication Distance Decreases when-

  • There is increased Speed of walking
  • Resistance offered for walking
  • Walking up hill
  • Poor General Health & Systemic diseases of the patient

Z Intermittent claudications ⇒ Rest pain ⇒ Ischemic skin changes ⇒ gangrene Large part of limb

Rest Pain Rest Pain is the pain felt even at rest. It is due to the Ischemia of the somatic nerves(cry of the dying nerves)

  • Felt in the foot (most distal parts)
  • Exacerbate on lying down or elevation of foot
  • Worse at night; patient sits in “hen-holding” position
  • Pressure of even bed clothes worsens the pain
  • Lessened by hanging the foot down or sleeping on a chair as the gravity aids in the blood flow to the nerves.
  • Patient may commit suicide

Graph View

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