Lower Limb Assessment FAQS

What is arterial disease?

Muscles require a good blood flow to function. If the blood flow is impaired, patients may experience symptoms. The more severe the impairment, the more severe the symptoms.

The underlying cause is usually disease (atherosclerosis) related to build-up of cholesterol in the arterial wall.

Typical features of arterial disease are:

  • Cramping pain on walking (intermittent claudication)
  • Pain in the muscles or foot at rest
  • Ulcers
  • Gangrene

The name Claudication derives from Claudius, the Roman Emperor who was believed to have walked with a limp due to arterial disease.

How is arterial disease investigated?

Initially with taking a patient’s history and performing an examination, supported by measurement of the blood flow in the arms and legs (Ankle Brachial Pressure Index, ABPI).

Patients may then require formal imaging of their circulation with a scan such as an ultrasound or CT scan, or both.

How is arterial disease treated?

There are two aspects to treating arterial disease: risk factor management, and interventions to increase the blood flow to the limb.

1. Risk Factor Management

All patients with arterial disease of the legs are at risk of complications from arterial disease throughout the body, including heart attack and stroke. This is because the disease affects all arteries, not just those of the legs.

To reduce the risk of such events, all patients should have their risk factors for arterial disease fully addressed (where they apply):

  • Good blood pressure control
  • Good diabetic control
  • Statin tablets to lower cholesterol
  • Use of antiplatelet or blood-thinning tablets as indicated
  • Stopping any form of cigarette smoking

This is undertaken in conjunction with your GP.

Many patients with lower limb arterial disease improve simply through addressing their risk factors.

2. Interventions to increase the blood flow to the limb

Improving blood flow to the limb and relieving or reducing symptoms, once the risk factors have been addressed, can be through:

  • Structured Exercise Programme (SEP)
  • Angioplasty (with or without stenting)
  • Arterial surgery
Is there National Guidance as to how I should be investigated and managed?

Mr Birchley manages private patients with arterial disease in the same manner whether NHS or private. His care complies with published National Guidance, available at: https://www.nice.org.uk/guidance/cg147/chapter/recommendations

The guidance recommends risk factor management, then a structured exercise programme for patients with claudication (claudicants.)

Severely disabled claudicants, or patents with an at-risk limb due to an inadequate blood supply may proceed direct to angioplasty or surgery.

Where can I access further information about Structured Exercise Programmes?

Further information regarding Structured Exercise Programmes for claudication is available through the following links:

NICE Guidance

American Heart Association

British Medical Journal

Cochrane Library

How much does the Lower Limb Assessment cost?

The initial consultation is £225 for 30-minutes.

The consultation includes taking a medical history, examination, Ankle-Brachial Pressure Index (ABPI) measurement and discussion around your condition. As a result:

  • Your care can be transferred to Mr Birchley’s NHS practice at the Royal Devon and Exeter Hospital if appropriate
  • An onward referral to another speciality or the Structured Exercise Programme can be made if it is your wish
  • Advice can be provided regarding the requirements of a Structured Exercise Programme if you wish to arrange this yourself
  • Imaging with a view to invasive treatment (angioplasty or surgery) can be arranged if appropriate
How much does the Structured Exercise Programme cost?

The costs are:

  • SEP Assessment consultation £175
  • SEP (36 sessions) £1495
  • Follow-up consultation £225
  • Total cost £1895
What does the structured exercise programme involve?
  • An initial session of one hour with the Programme Director to allow baseline assessments and for a bespoke plan to be devised
  • Thirty-six sessions over three months
  • A follow-up consultation with Mr Birchley

Please see the Structured Exercise Information Programme leaflet on this page for further details.