Case 3

A 54-year-old male presents with a 4-hour history of sudden onset pain in his left calf on walking. He thinks he may have strained a muscle and is only able to manage about a few yards before he stops. The pain then settles over a couple of minutes and he is able to continue. He smokes 20 cigarettes a day but has no history of diabetes or hypertension.

On examination, he has good, palpable femoral and popliteal pulses on both sides. His left popliteal artery feels enlarged. You cannot feel any pedal pulses on the left but there is a palpable posterior tibial pulse on the right.

What else do you notice?

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He has reduced sensation over his forefoot and some weakness in his toes. There is no calf tenderness.

What is the most likely diagnosis?

How would you confirm that this is acute leg ischaemia?

Select one or more options.

You measure his ankle brachial pressure indices and confirm a pressure of 0.3 on the left and 0.7 on the right.

What urgent baseline tests do you request?

Select one or more options.

What initial management should be undertaken in the ED?

Select one or more options.

What is the most appropriate next step?

What is the risk of limb loss following thrombosis of a popliteal aneurysm?