Arterial insufficiency in the leg usually presents as muscle pain on exercise (intermittent claudication). Blood flow through the narrowed major arteries may be adequate to meet resting needs but not the increased requirements of exercise. When collateral flow is also impaired or there is further major arterial occlusion then rest pain in the foot, trophic skin changes and eventually gangrene result. Medical treatment has been largely unsuccessful. Systemically acting vasodilators are often given but may actually reduce blood flow in ischaemic areas by diverting it to healthy responsive vascular beds.1 2
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