Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- asymptomatic
- intermittent claudication
- thigh or buttock pain with walking that is relieved with rest
- diminished or absent pulse
- sudden onset of severe leg pain accompanied by numbness, weakness, pale, and cold leg
Other diagnostic factors
- erectile dysfunction
- leg pain at rest
- gangrene
- non-healing wound/ulcer
- muscle atrophy
- dependent rubor
- pallor when the leg is elevated
- loss of hair over the dorsum of the foot
- thickened toenails
- shiny/scaly skin
- pale extremity
- nerve loss
Risk factors
- smoking
- diabetes
- hypertension
- elevated C-reactive protein (CRP)
- hyperlipidaemia
- age >40 years
- history of coronary artery disease/cerebrovascular disease
- hyperhomocysteinaemia
- low levels of exercise
- vasculitis/inflammatory conditions
- arterial fibrodysplasia
Diagnostic investigations
1st investigations to order
- ankle-brachial index (ABI)
Investigations to consider
- toe-brachial index (TBI)
- segmental pressure examination
- pulse volume recording
- duplex ultrasound
- continuous wave Doppler ultrasound
- exercise ankle-brachial index (ABI)
- catheter angiography
- CT angiogram
- magnetic resonance angiography (MRA)
Treatment algorithm
acute limb ischaemia
claudication (not lifestyle-limiting)
claudication (lifestyle-limiting)
chronic severe limb ischaemia (critical limb ischaemia)
Contributors
Authors
Leila Mureebe, MD, MPH, MMCi, FACS
Associate Professor of Surgery
Duke University Health Care
VA Mid Atlantic Healthcare System
Durham
NC
Disclosures
LM declares that she has no competing interests.
Acknowledgements
Dr Leila Mureebe would like to gratefully acknowledge Dr Ehrin Armstrong and Dr Kosmas I. Paraskevas, previous contributors to this topic.
Disclosures
EA is an advisory board member for Abbott Vascular, Boston Scientific, Medtronic, and Philips. EA and KIP are both authors of references cited in this topic.
Peer reviewers
Khaled Ziada, MD
Assistant Professor
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Disclosures
KZ declares that he has no competing interests.
Debabrata Mukherjee, MD
Gill Foundation Professor of Interventional Cardiology
Director of Cardiac Catheterization Laboratories
Gill Heart Institute
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Disclosures
DM declares that he has no competing interests.
Differentials
- Spinal stenosis
- Arthritis
- Venous claudication
More DifferentialsGuidelines
- ACR Appropriateness Criteria: sudden onset of cold, painful leg
- Canadian Cardiovascular Society guidelines for peripheral arterial disease
More GuidelinesPatient information
High cholesterol
Peripheral arterial disease
More Patient information
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