It is a lack of blood flow in the legs due to a continued blockage of the arteries of the lower limbs.
It usually presents in people over the age of 50 years old with atherosclerosis, which gradually blocks the blood vessels. The slow blockage favours the appearance of new blood vessels, which try to compensate for the lack of blood flow (collateral circulation).
It manifests with pain in the legs, first when walking and, at a later stage, becoming permanent. The sustained blood flow restriction causes skin, hair and toenail alterations. If it is very severe, it can cause skin ulcers, which will evolve into necrosis and gangrene in the limb.
The diagnosis is made clinically, by means of the medical history and a physical examination, and is confirmed by examination with a continuous Doppler ultrasound.
Treatment will depend on the stage of the disease, for which a vascular surgeon should always be consulted earlier. In the initial stages, it is sufficient by managing the risk factors (quit smoking, controling the in-blood sugar levels, blood pressure, avoid obesity, control the consumption of cholesterol-rich foods, exercising daily, etc.) together with antiaggregant medication. In more advanced stages, invasive measures will be required (angioplasty, bypass).
- Marc E Mitchell, Jeffrey P Carpenter. Overview of acute arterial occlusion of the extremities (acute limb ischemia). UpToDate May 31, 2016.
- David G Neschis, Michael A Golden. Treatment of chronic lower extremity critical limb ischemia. UpToDate Jul 17, 2015.
- Dormandy J, Heeck L, Vig S. The fate of patients with critical leg ischemia. Semin Vasc Surg 1999; 12:142.
- Oresanya L, Zhao S, Gan S, et al. Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study. JAMA Intern Med 2015; 175:951.
- Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S:S5.
- Mark A Creager, Joseph Loscalzo. Enfermedades arteriales de las extremidades. Harrison. Principios de Medicina Interna. Volumen 2. 19º Edición. 1643:1650.
