🚶‍♂️ Leriche Syndrome: buttock claudication + erectile impotence + absent femoral pulses ➝ due to aortoiliac occlusion (pudendal artery arises from internal iliac).

ℹ️ About

🦵 Intermittent claudication = exertional leg pain caused by anaerobic muscle metabolism due to reduced blood supply.

🩺 Causes

Chronic atherosclerosis / arteriosclerosis (most common).
Buerger’s disease (thromboangiitis obliterans).
Arteritis (e.g. Takayasu’s disease).

⚡ Aetiology of Acute Ischaemia

Thrombosis of an atherosclerotic artery.
Embolism to a previously normal artery (often cardiac source: AF, mural thrombus, endocarditis).

📍 Common Sites

🩸 Aorto-iliac ➝ buttock/thigh/calf pain + impotence (Leriche syndrome).
🩸 Iliac-femoral ➝ thigh and/or calf pain.
🩸 Superficial femoral-popliteal ➝ calf pain only.

⚠️ Risk Factors

Age, smoking, hypertension, hypercholesterolaemia, diabetes.
History of MI, TIA, ischaemic stroke, or carotid disease.

🧾 Clinical Features

Cramp-like pain in calves, thighs, or buttocks on exertion ➝ relieved by rest (hence “intermittent”).
Causes limping ➝ “claudicare” = to limp.
Represents peripheral vascular disease (PVD) in medium/large arteries.
Progressive stenosis ➝ pain occurs earlier with exertion, eventually leading to rest pain.
Signs: ischaemic ulcers, gangrene, shiny skin, hair loss, absent pulses.
Often male, smoker, hypertensive, hypercholesterolaemic, diabetic.
Frequently associated with systemic atherosclerosis (MI, stroke, carotid disease).

🦵 Ankle-Brachial Pressure Index (ABPI) = BP at Ankle ÷ BP at Arm (Brachial)

ℹ️ About

🧴 Inflate BP cuff around lower calf (just above ankle joint).
🩺 Use Doppler probe over dorsalis pedis & posterior tibial artery ➝ take the higher of the two as ankle pressure.
📉 Record pressure when pulse disappears.
💪 Measure brachial pressure (arm).
✅ Normal: ankle–brachial difference < 10 mmHg.
⚠️ PAD present if ABPI < 0.9.
Formula ➝ Ankle pressure (mmHg) ÷ Brachial pressure (mmHg).

📊 Interpretation

ABPI Value	Interpretation
> 1.3	🪨 Calcified, non-compressible arteries (e.g. diabetes, CKD).
0.8 – 1.3	✅ Normal.
0.5 – 0.8	⚠️ Mild arterial disease ➝ mild claudication.
0.4 – 0.6	⚠️ Moderate arterial disease ➝ ulcers, claudication, rest pain.
< 0.4	🚨 Severe disease ➝ critical ischaemia with rest pain/gangrene.

👥 Those at Risk

Age / Condition	Risk Factors
Age ≥65 years	📈 General vascular risk due to age.
Age 50–64 years	Risk factors for atherosclerosis: 🍬 Diabetes mellitus 🚬 Smoking history 🧈 Hyperlipidaemia 💉 Hypertension 👨‍👩‍👦 Family history of PAD
Age <50 years	🍬 Diabetes mellitus ➕ ≥1 additional atherosclerotic risk factor
Known atherosclerotic disease in another vascular bed	Other conditions: ❤️ Coronary artery disease 🧠 Carotid artery stenosis 💪 Subclavian artery stenosis 🩺 Renal artery stenosis 🍽️ Mesenteric artery stenosis 🫀 Abdominal aortic aneurysm

🌙 Rest Pain

Pain at rest (especially in foot/ankle at night).
Relieved by dangling leg off bed (gravity improves perfusion).
Precedes ulceration and gangrene ➝ a marker of critical limb ischaemia.

🚨 Acute Ischaemia

Classic “6 Ps”: Pain, Pallor, Pulselessness, Perishingly cold, Paraesthesia, Paralysis.
Absent capillary refill and dusky mottling are late signs.

🧪 Investigations

Bloods: FBC, U&E (CKD common), LFTs, ESR, lipids, glucose, HbA1c.
📉 ECG: may show old MI, AF, or LVH.
🧪 Elevated lactate in acute ischaemia.
🏃 Treadmill test ➝ measure functional claudication distance.
📏 Ankle–Brachial Pressure Index (ABPI): normal >0.9; claudication 0.4–0.9; rest pain/critical ischaemia <0.4.
🖼️ Imaging: Duplex/CT/MR angiography for treatable lesions.

💊 Management

📋 Best medical therapy: Aspirin (or clopidogrel), statin, strict smoking cessation, BP control, diabetes control, exercise programmes.
🩺 Endovascular ➝ angioplasty ± stenting (for focal disease).
🔧 Surgical ➝ bypass grafting (for extensive disease).
🚨 Acute ischaemia ➝ emergency revascularisation (embolectomy, thrombolysis, bypass) or amputation if unsalvageable.

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Intermittent Claudication

ℹ️ About

🩺 Causes

⚡ Aetiology of Acute Ischaemia

📍 Common Sites

⚠️ Risk Factors

🧾 Clinical Features

ℹ️ About

📊 Interpretation

👥 Those at Risk

🌙 Rest Pain

🚨 Acute Ischaemia

🧪 Investigations

💊 Management

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