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3 - Chronic lower limb ischaemia, critical ischaemia and the diabetic foot

Chris Davies
Southampton General Hospital, UK
Cliff Shearman
Southampton General Hospital, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
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Key points

  • Peripheral arterial disease (PAD) affects approximately 30% of the adult population

  • PAD is a powerful marker of cardiovascular risk and the risk is related to the severity of the PAD

  • Risk factor management has been proven to reduce cardiovascular risk but many patients do not receive adequate treatment

  • The optimum treatment to improve walking in patients with intermittent claudication is best medical treatment, supervised exercise and angioplasty

  • Angioplasty and surgery appear to be equivalent in treating critical limb ischaemia (CLI). However, angioplasty is cheaper due to reduced length of hospital stay

  • Diabetic foot complications are a common cause of hospital admission and often precede amputation. The majority of amputations in the UK are carried out in patients with diabetes

  • Patients with diabetes should be screened annually for neuropathy and PAD

  • Multi-professional team approach to the management of diabetic foot complications can reduce amputation rates


Atherosclerotic arterial disease affecting the legs, peripheral arterial disease (PAD), is very common. In many patients it is asymptomatic but commonly the first manifestation of PAD is pain in the leg on walking, intermittent claudication. In some patients the blood supply to the leg becomes further reduced to a level when pain is experienced at rest and ulceration and gangrene occur (critical limb ischaemia, CLI). In the Edinburgh Artery study it was found that 4.5% of men and women over 55 years of age had intermittent claudication but a further 25% had evidence of asymptomatic disease.

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 58 - 71
Publisher: Cambridge University Press
Print publication year: 2011

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