Lower Limb Arterial

The arteries in the leg supply the muscles and tissue with nutrients and oxygen. Inadequate supply of oxygen and nutrients causes a condition known as ischaemia. The vessels can be affected by a range of conditions. These conditions include atherosclerosis, diabetes, smoking, kidney disease and aneurysmal degeneration. It is possible to have blockage of an artery without any adverse effects because there are some areas with a duplicate blood supply.

The ischaemia can cause a range of symptoms. There may be no symptoms, pain in the muscles on walking (claudication), pain in the foot particularly at night (rest pain), ulceration or poorly healing wounds, or death of skin (gangrene). The urgency for treatment depends on the symptoms, and generally constant pain or pain at night, ulceration and gangrene require prompt treatment. Severe pain with loss of movement or sensation is an emergency requiring presentation to an emergency department.

Treatment of narrowed or blocked arteries usually is only required once symptoms are present. The treatment usually occurs after extensive investigation including ultrasound-doppler examinations, pressure studies and angiography. Treatment can sometimes be performed in combination with angiography using a balloon to widen the artery, called angioplasty. The best treatment may be with bypass or endarterectomy at open surgery.

Abnormal widening of the arteries due to weakening of the vessel wall is called aneurismal degeneration. The weakness can be due to multiple factors including genetic/familial, infective, connective tissue disease, smoking, trauma, and others. Most are age related conditions. They can be associated with aneurysms in the abdomen. As the artery expands, the blood flow through them slows and clot can form at the sides and suddenly block the artery. Sudden blockage which can be very severe and threaten major leg amputation in one quarter of cases. The clot at the side of the aneurysms can also break off and be swept down stream as emboli which can cause areas of gangrene in the foot. Aneurysms can rarely rupture causing severe blood loss.

Aneurysms are usually asymptomatic until they cause complications which can be severe. They are often accidental discoveries. Treatment is usually performed with replacement or bypass and exclusion of these arteries before the development of these complications. Occasionally these can be treated with minimally invasive techniques at angiography.