Approach

Vital points

• Name
• Age
• Occupation 

Pain of intermittent claudication

1. Site
   • Stenosis of lower aorta and common iliac arteries: buttock claudication + importence
   • External iliac artery: thigh claudication
   • Superficial femoral artery: calf claudication
2. Intensity
   • Felt in muscles - due to increased oxygen demand
   • Lactic acidosis occurs when insufficient oxygen demands are met
   • Pain due to anoxia, acidosis and build-up of metabolites
3. Precipitating and relieving factors
   • Exercise after a fixed distance
   • Comes on more rapidly walking uphill
   • Relieved by a few minutes of resting

Rest Pain

1. Site
   • Occurs in the least perfused area of the leg (toes and forefoot)
2. Intensity
   • Severe
   • Wakes patient up from sleeping
3. Precipitating and relieving factors
   • Comes on at night (lying flat in bed - loss of gravity, reduced cardiac output at rest, relative dilation of skin vessels due to warmth of bedclothes)
   • Relieved by getting up and walking on a cold floor
   • Pain relieved by hanging leg off bed

Critical Ischaemia

1. Ulcers or gangrene
2. Rest pain for >2w weeks
3. ABPI <50mmHg

Functional impact

• Life, work, sleep
• Going to shops
• Walking aids
• Limp

Differential diagnosis

Calf pain due to

1. Musculoskeletal: knee, ankle, hip pathology
2. Neurological: spinal stenosis
3. Vascular: intermittent claudication, deep vein thrombosis