Clinical evaluation of chronic lower limb ischaemia and their management

Abstract

Background: Chronic lower limb ischaemia is a clinical entity comprising of etiologies such as atherosclerosis, thromboangitis obliterans and other rare forms of non-specific and specific arteritis like SLE, Rheumatoid arteritis etc. In western countries atherosclerosis predominates, but in Indian subcontinent, TAO is much more common.

Methods: A good clinical history and detailed clinical examination was done with the presumptive diagnosis of either TAO or Atherosclerosis. The degree of the vascular insufficiency and the extent of the disease were assessed clinically by noting the severity of the symptoms, ankle brachial index, temperature changes and assessment of pulsations. Doppler study was done in all patients. After a presumptive diagnosis, an essential laboratory investigation was done. Some of the patients were managed conservatively and others underwent surgery. The operative treatment was based on the symptoms and patient’s condition, with lumbar sympathectomy and amputations.

Results: Chronic lower limb ischaemia accounts for 1.12% of all surgical admissions in a period of one year. Only two diagnosis were found in our study, namely Atherosclerosis obliterens (8 cases) and TAO (42) cases. Out of the 50 cases, 40 patients underwent some form of surgical treatment. Four patients were managed conservatively and 6 patients refused surgery. Both subjective improvements in pain relief and temperature were noted in 23 patients. Three patients did not show any changes, and 2 patients had progression of the disease and underwent below knee amputation later in the same study period.

Conclusions: Though the role of lumbar sympathectomy had been debated in the recent past as a treatment modality for chronic lower limb ischaemia, it still remained an important interventional measure in limb salvage with good results.