Síndrome de isquemia crónica de las extremidades inferiores

Chronic limb ischemia is growing in prevalence and its incidence increases with age and up to 20 % of people aged over 60. The incidence is also high in smokers, diabetes patients, and those with coronary disease. The most common initial symptom is intermittent claudication. More severe or critical limb ischaemia can present with pain at rest, ulceration, tissue loss and/or gangrene. This severe form is associated with high rates of limb loss, morbidity and mortality. A focused history should identify the presence and severity of intermittent claudication and any critical limb ischaemia. Examination should concentrate on the palpation of lower limb pulses and look for signs of critical ischaemia such as ulceration. The key primary care investigation in suspected peripheral arterial disease is measurement of the ankle brachial pressure index. Lifestyle interventions are a key component of management. Pharmacological treatment, open surgery and endovascular procedures are indicated in selected patients.