Chronic Lower Extremity Ischemia

The history and physical examination of a patient with chronic lower extremity pain may help differentiate symptoms of vascular insufficiency from sciatica, osteoarthritis, diabetic neuropathy, and spinal stenosis. Chronic vascular pain may be intermittent or constant. Intermittent claudication is classically described as cramping muscular pain (calves, thighs, buttocks) developing at a predictable level of physical activity with resolution after several minutes of rest. The anatomic level of disease is usually above the patient’s area of symptoms, i.e., calf claudication is secondary to superficial femoral disease and thigh/buttock claudication is caused by aortoiliac disease. More than one level of disease, however, needs to develop prior to the onset of symptoms. The patient’s clinical history may also suggest progression of disease as in the case of diminishing activity tolerance over time.