SU27.1-2 | Occlusive Arterial Disease — Summary & Reflection

KEY TAKEAWAYS

Occlusive arterial disease is one spectrum: intermittent claudication (cramping muscle pain on walking, relieved by rest) → rest pain (nocturnal forefoot pain relieved by dependency) → tissue loss (ulcer/gangrene); rest pain >2 weeks and/or tissue loss = critical limb-threatening ischaemia. Atherosclerosis is the commonest cause (older smokers/diabetics); Buerger's disease affects young male smokers' distal vessels and demands smoking cessation. Severity is graded by Fontaine (I–IV) and Rutherford. Examination = inspect, palpate the femoral/popliteal/posterior tibial/dorsalis pedis pulses, Buerger's test, and the ABPI (normal 0.9–1.3; <0.9 disease; <0.4 critical; >1.3 falsely high from calcified diabetic/renal vessels); image with duplex → CT/MR → catheter angiography. Claudication is treated with best medical therapy (smoking cessation, supervised exercise, statin, antiplatelet); critical ischaemia needs revascularisation (endovascular or bypass). Acute limb ischaemia — the six P's (pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold) — is an emergency: immediate IV heparin then embolectomy/thrombolysis/bypass, with amputation for an unsalvageable limb.

REFLECT

Think back to a patient you have examined with leg pain, or imagine clerking the next one. Did you actually palpate all four lower-limb pulses on both sides, look for trophic changes and ulcers, and — crucially — distinguish the slow story of claudication from the emergency of a cold, pulseless limb? Would you have measured an ABPI at the bedside, and would you have paused before trusting a high reading in a diabetic foot? Reflect on how recognising peripheral arterial disease as a marker of whole-body atherosclerosis would change your management — not just treating the leg, but starting the statin and antiplatelet that may prevent this patient's heart attack or stroke.