A 70-year-old man visits a neurologist for “sciatica”. He states that he has been having pains in his thighs and buttocks on both sides. On questioning, he reveals that it worsens with exertion and has been limiting his physical activity. Medications include antihypertensives, oral hypoglycemics, and sildenafil. On exam, he is noted to have symmetrically atrophied lower extremity muscles. From where does this patient’s disease process likely originate?
1.Neuromuscular junction
2.Vasculature
3.Nerve roots
4.Peripheral nerves
5.Spinal cord
exp:
The triad of symmetric, bilateral thigh and buttock claudication, impotence, and symmetric atrophy of the lower extremities is likely due to chronic ischemia from aortoiliac occlusion or Leriche syndrome, a vascular cause of lower extremity pain.
Peripheral arterial disease (PAD) is the result of atherosclerosis leading to narrowing of the major arteries distal to the aortic arch. Symptoms depend on the location of the arterial narrowing, but claudication is the most common symptom. A thorough history is necessary as patients may have a difficult time distinguishing between exertional pain due to increased oxygen demand and exertional pain due to bending or lifting objects (as can be seen with sciatic pain).
Illustration A shows how to calculate the ABI. The ABI, the ratio of the highest SBP in the dorsalis pedis (DP) or posterior tibial (PT) arteries of each leg to that of the highest systolic blood pressure (SBP) in the brachial artery of each arm. A normal resting ABI value is between 0.9–1.4.