Chattanooga Wireless Professional - Treatment of Arterial Insufficiency in the Lower Limbs

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14.13 Treatment of arterial insufficiency in the lower limbs
We will limit this chapter to insuciency of the arteries in the lower limbs.
High blood pressure, smoking, cholesterol and diabetes are among the main causes of progressive
deterioration of the arterial walls (arteriosclerosis).
This presents as narrowing of the arteries with, consequently, a reduction in the blood flow in the tissues
downstream of the narrowed arteries.
The less well irrigated tissues suer and become hypoxic, all the more so because the width of the arteries
has shrunk and more intense activity requires more oxygen.
Arterial insuciency in the lower limbs is conventionally divided into four clinical stages. These four
stages (I, II, III, and IV) depend on the approximate severity of the loss of blood flow and the tissue-related
consequences.
Stage I is asymptomatic. In a clinical examination, an arterial murmur can be heard, which is evidence of
narrowing, although the patient has no complaint.
In Stage II, the reduction in the flow causes pain in the legs when walking. At rest, the flow is sucient,
but it cannot meet tissue requirements during physical activity: the patient suers from “intermittent
claudication” (IC).
This means that pain occurs after walking a certain distance (the shorter the distance, the more severe the
condition); in the end, this pain makes the patient stop: then, after a recovery period, the pain lessons and
the person can resume walking until the cycle starts again.
Stage III is characterised by constant pain, including when at rest. Blood flow is so reduced that the tissues
constantly suer from hypoxia with a continual presence of acid metabolites.
Stage IV corresponds to suering that is so advanced that tissue necrosis with gangrene occurs. This is
then called critical ischaemia, a condition which often leads to amputation.
Only Stages II and III can benefit from treatment by electrostimulation.
Stage IV is an emergency situation and requires surgical treatment.
Stage I is asymptomatic and the patient has no complaint.