Chronic Ischemia of the Lower Extremity

Conditions Associated with Acute Leg Ischemia

It is sometimes difficult to differentiate between acute leg ischemia, deterioration of chronic leg ischemia, and just severe end-stage chronic disease in general. Periods of pain escalation bring patients with chronic ischemia to the emergency department. Accentuated pain in these patients has a wide range of origins. Decreased foot perfusion can be due to dehydration or lowered systemic pressure as a consequence of heart failure or a change in medication. Ulcers are frequently painful, especially when complicated by infection or when dressings are changed. History and examination of vital functions and the leg usually disclose such conditions and can also sufficiently rule out acute leg ischemia that needs urgent treatment.

Patients with chronic ischemia benefit from careful planning of their treatment and should not – with few exceptions – be expeditiously treated. Elective therapy includes weighing risk factors against the outcome of the proposed treatment and all the work-up that is needed to get this information. (It is beyond this book’s purpose to describe the management of chronic ischemia.) In the emergency department it is sensible to identify and directly treat the patients with true acute leg ischemia and schedule treatment of patients with chronic disease for later. Examples of findings in medical history and physical examination are listed in Table 5.

Table 5. Medical history and physical examination

findings suggesting chronic leg ischemia

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