Ischaemic neuropathy in occlusive lower limb arterial disease at the stageof ischaemia on effort.

Acute or chronic prolonged ischaemia of the limbs may cause lasting neurolo gical damage. This has been shown in clinical, electrophysiological and ana tomopathological studies. The aim of this study was to search for signs of neurological suffering during ischaemia of effort. Twenty patients with occlusive lower limb arterial disease with ischaemia o f effort were studied. None of the patients had other causes of neuropathy : none of the patients had potentially neurotoxic therapy. All underwent ha emodynamic assessment (Doppler ultrasonography treadmill test, transcutaneo us oxygen diffusion) and electrophysiological study (nerve conduction studi es and an electromyogramme). Ten patients had abnormalities during stimulat ion-detection and on electromyography. These abnormalities were always obse rved in the limbs with the poorest blood flow. The pressure index and trans cutaneous oxygen diffusion in lying position were significantly lower (pres sure index : 0.43 vs 0.72, p < 0.03; TcPO2 : 20.3 vs 27.2, p < 0.04). The authors consider that effort ischaemia is associated with neurological damage. Repeated transient episodes of ischaemia could cause neuropathy.