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Medical Science Optional daily answer writing practice for CSE 2023 – Dec 6

Topic: Peripheral arterial diseases, varicose veins, coarctation of aorta

Question: Enumerate the signs of lower limb arterial ischemia. Outline the diagnostic work-up in a 62 year old male with, atherosclerotic lower limb, peripheral arterial disease.

Click here for Reference Material-This material is informational alone and is not specifically prepared as an answer for any question. Readers may do their own research before finalising diagnoses according to the characteristics unique to each question. Readers should not proceed without cross-referencing with relevant textbooks as well as standard guidelines available.

Signs of lower limb arterial ischemia include:

  • Intermittent claudication – Calf pain/cramps induced by walking that is relieved by rest.
  • Rest pain – Pain in toes/feet even at rest, usually worse at night.
  • Pallor – Pale, cold feet with delayed capillary filling (>2 seconds) on elevation.
  • Temperature changes – Cold/mottled feet with reduced sweating.
  • Ulceration/gangrene – Tissue necrosis over toes/feet due to critical limb ischemia.
  • Atrophy – Wasting of foot muscles (tibialis anterior, gastrocnemius).
  • Trophic changes – Dry scaly skin, thinning/brittling of toenails.

Diagnostic workup for a 62-year-old male with atherosclerotic lower limb PAD would include:

  • History and clinical exam – Assess symptom severity, risk factors.
  • Ankle-brachial index (ABI) – Doppler ultrasound ratio of <0.9 suggests >50% stenosis.
  • Duplex ultrasound – Assess extent and degree of arterial stenosis/occlusion non-invasively.
  • CT or MR angiography – Preferable if inconclusive duplex or critical limb to evaluate run-off vessels in thigh/pelvis.
  • Angiogram – Gold standard for correlating anatomy if revascularization is planned (endovascular or open surgery).
  • Laboratory tests – FBS, lipids, renal/liver function to optimize medical management and risk-stratify surgery.
  • Transthoracic echocardiogram – To evaluate cardiac function if revascularization is considered.

The goal is to determine severity, extent of disease and develop an individualized revascularization/wound healing plan if indicated. Close monitoring of symptoms and expedited review is key.

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