S&S of NCLI

• S&S of non-critical lower limb ischaemia:

  • symptomatic lower limb ischaemia is associated with:
  • intermittent claudication - main feature
  • diminished/absent pulses (absent pulses are a medical emergency as it means an atheroma has ruptured and a thrombus has formed, completely interrupting blood flow, causing necrosis of the surrounding muscle/tissue, so can lead to amputation if not managed asap)
  • atrophic skin changes due to lack of blood flow delivering nutrients
  • skin colouration
  • elevation pallor and dependent rubor - soles of feet look white when feet are elevated and red when feet are on the ground (due to surrounding arterioles maximally vasodilating when feet are on the ground and odema -> alteration of starlings forces -> pushing fluid out into periphery)
  • sensory disturbances
  • cold extremities
  • sarcopenia
• S&S of non-critical lower limb ischaemia:

  • Intermittent Claudication:
  • excruciating muscle pain
  • obstruction of a vessel causing mismatch between dynamic oxygen demand and actual blood flow, where blood supply does not meet metabolic demands
  • tissues not receiving oxygen become ischaemic, release factors that stimulate nerve endings, causing sensation pain
• S&S of non-critical lower limb ischaemia:

  • Intermittent Claudication:
  • activity induced - activity limiting pain
  • affects ~ 50% of those with peripheral vascular disease
  • regional - dependent on which artery is obstructed e.g.
  • aorto-iliac affects the buttocks/thighs
  • femero-popliteal affects the calves - most common
  • pain onset - ischaemic threshold varies from person to person and depends on how much activity a person can do before pain is limiting their activity

  
• Outcome of intermittent claudication:

  • 40% improve over 2 years+
  • 40% unchanged
  • 20% deteriorate & develop rest pain / critical limb ischaemia
  • 2 to 8% -> amputation
• S&S of non-critical lower limb ischaemia:

  • sarcopenia
  • chronic disease drives long term skeletal muscle dysfunction, secondary to loss of contractile proteins and loss of muscle fibres
  • this reduces strength and aerobic capacity
• S&S of non-critical lower limb ischaemia:

  • sarcopenia
  • sedentary behaviour/disuse atrophy -> skeletal muscle atrophy/sarcopenia
  • age related sarcopenic changes -> skeletal muscle atrophy/sarcopenia
  • heart failure + renal disease + diabetes mellitus + atherosclerosis + local ischaemia + hypertension -> inflammatory driven process -> skeletal muscle atrophy/sarcopenia
• S&S of non-critical lower limb ischaemia: