Lower Limb Ischaemia

A reduced oxygen supply to the tissues of the legs as a result of a poor blood supply

  • More common over the age of 40
  • More common in males
  • Sometimes runs in families
  • Smoking, a high-fat diet, lack of exercise, and excess weight are risk factors

If blood flow to the legs is reduced, the leg tissues may became deprived of oxygen, which my led to a cramp-like pain on exertion (called claudication). Reduced blood flow is usually due to atherosclerosis, a build-up of fatty deposits in artery walls, whose effects are often most noticeable on the lower limbs. People who have an inherited tendency towards high cholesterol levels (see Inherited hyperlipidaemias) are more likely to develop atherosclerosis, as are those who have had diabetes mellitus for a long time. A high-fat diet and smoking also increase the risk. About 9 in 10 people with lower limb ischaemia smoke.

What are the symptoms?

The symptoms of lower limb ischaemia usually develop gradually over months or years. Symptoms may affect one leg more than the other. In the initial stages of the condition, blood flow to the legs may be adequate to supply the tissues when at rest but not on exertion. The main symptom is a cramp-like pain in the legs (known as claudication) with the following features:

  • Affects one or both calves when walking and may be severe.

  • Consistently appears after walking a particular distance.

  • Comes on sooner when walking uphill or in cold temperatures.

  • Is relieved by rest and usually disappears after several minutes.

As the disease progresses, the distance a person is able to walk before experiencing pain gradually decreases, so that eventually pain may be present at rest. Additional symptoms of lower limb ischaemia may then include:

  • Pale, cold feet.

  • Persistent leg or foot ulcers.

If a blockage occurs in blood vessels in the pelvic region, blood flow is reduced to the whole of the lower body, and as a result there may be pain in the buttocks and, in men, erectile dysfunction. If the blood vessel suddenly becomes completely blocked by a clot (see Thrombosis and embolism), the symptoms may worsen rapidly. Without immediate treatment, death of tissues in the feet and legs may occur (see Gangrene).

What might be done?

If a blockage occurs in blood vessels in the pelvic region, blood flow is reduced to the whole of the lower body, and as a result there may be pain in the buttocks and, in men, erectile dysfunction. If the blood vessel suddenly becomes completely blocked by a clot (see Thrombosis and embolism), the symptoms may worsen rapidly. Without immediate treatment, death of tissues in the feet and legs may occur (see Gangrene).

Treatment is aimed at increasing the blood flow to the tissues in the legs. Affected arteries may be widened using a technique known as angioplasty, in which a balloon on the tip of a catheter is passed into the artery and inflated. Sometimes, a stent (rigid tube) may then be inserted into the artery to help keep it open. In some cases, surgery is carried out to bypass affected arteries (see Femoral artery bypass graft).

Taking a low dose of aspirin daily may help to prevent blood clots from developing. If a clot has formed, you may be given drugs to dissolve it and to prevent more clots from forming (see Drugs that prevent blood clotting). In some cases, the clot needs to be removed surgically or by using a special catheter. If gangrene has developed, amputation of part or all of the affected limb may be necessary.

If you smoke, it is vital that you stop immediately. The nicotine in cigarettes causes blood vessels to constrict, further reducing blood supply to the legs. Even one cigarette can produce a constricting effect that lasts for several hours, and you need to give up smoking completely to improve the outlook once lower limb ischaemia is diagnosed. If you continue to smoke, the disease is likely to progress, and surgery may be required.

In addition, you should follow a healthy diet and try to walk for longer periods each day to build up the amount of exercise you can do without feeling pain (see Taking regular exercise). Adopting these measures may enable you to prevent the condition from worsening.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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