Clinical Presentation

Patients with peripheral vascular disease may present with one of the following two syndromes [1-4]: i.Acute ischaemic syndrome (Rest pain or tissue necrosis):

Acute interruption of arterial supply almost always causes irreversible tissue amage and resultant tissue loss (gangrene). Two scenarios are encountered:

• Acute arterial embolism from a diseased heart valve, most often in a patient with atrial fibrillation. Many of these patients do not have a precedent history of intermittent claudication. These patients uncommonly present for MRA as patients are typically treated immediately by percutaneous catheter directed thrombolysis or surgical embolectomy.

• Patients with prior intermittent claudication, with "acute-on-chronic" symptoms.

2. Chronic ischaemic syndrome (Intermittent claudication):

Responsible atherosclerotic lesions occur anywhere from the infra-renal abdominal aorta to the feet and multiple distal lesions may mimic a single more proximally placed lesion. Multiple lesions are the rule. However, as the disease tends to affect the lower limbs asymmetrically, patients usually present with unilateral symptoms. However, pre-existing "asymptomatic" disease on one side may be "masked" by successful treatment of the symptomatic limb.

Fontaine has developed the following classification for clinical staging of peripheral artery oc-culusive disease PAOD (Table 1).

Table 1. Fontaine classification

Stage

Manifestation

I

Asymptomatic (Pulse deficit only on

examination)

II

Arterial insufficiency with exercise

(Pulse deficit + claudication)

III

Arterial insufficiency at rest

(Pulse deficit + rest pain)

IV

Local tissue loss (Pulse deficit + gangrene)

Human Tibial Artery
Fig. 1 a, b. Normal anatomy of the leg A Common femoral artery B Deep femoral artery C Superficial femoral artery D Popliteal artery E Anterior tibial artery F Posterior tibial artery G Peroneal artery

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