• Predominantly disease of lower extremities
• In arms, subclavian and axillary mostly affected, radial and ulnar if diabetic
• In legs, femoropopliteal disease more common than aortoiliac disease
• Indicator for early death (from myocardial infarction [MI] and strokes) and imminent limb loss
• Single arterial segment obstruction limits walking to half to 1 block on average prior to onset of claudication pain
• Also known as peripheral artery insufficiency
• Affects 20% of population > age 70
• Indicates atherosclerotic disease; high risk of death from MI or stroke
• 20% die of nonatherosclerotic causes
• Intermittent claudication
-Pain, fatigue, cramping in leg muscles (most often calf) with walking; relieved by 2-5 min rest
-Is reproducible and does not occur at rest
-Thigh pain if occlusion proximal to profunda femoral, gluteal pain if proximal to hypogastric arteries
-Leriche syndrome: Aortoiliac disease— claudication of hip, thigh, buttock, atrophy of leg muscles, impotence, and diminished femoral pulses
-Sensation usually intact except in cases of peripheral neuropathy (diabetes)
• Ischemic rest pain
-Severe, burning pain in forefoot aggravated by leg elevation, improved with leg in dependent position
-Grave symptom caused by ischemic neuritis and tissue necrosis
-Indicates advanced arterial insufficiency
-Without treatment, results in gangrene and amputation
-Often preceded by claudication
• Nonhealing wounds ulcers
-Trivial trauma may cause wounds in pts with PVOD
-Commonly located on toes, or distal foot
-Usually painful with eventual gangrene
• Erectile dysfunction
• Diminished pulses, bruits (may be present at stenosis), pallor, reactive hyperemia, rubor, decreased temperature in foot, ulceration, tissue necrosis of toes, muscle atrophy, loss of hair on foot, thickening of toenails (slow keratin turnover), skin atrophy
• Noninvasive vascular tests: ABIs (ankle to brachial index)
• ABI < 1.0 indicates occlusive disease, rest pain typically ABI < 0.4
• Calcified vessels may not be compressed and suspected when ABI > 1.2 and does not correlate to clinical status (diabetics often elevated ABI, measure toe-brachial index (TBI)
• Segmental limb pressures: Measure pressure and pulsatile wave forms from thigh to foot to identify location of occlusive disease
• Exercise ABI done within 1 min of exercise may help diagnose occlusive disease
• Color duplex: Can identify arterial lesions but is operator dependent
• Arteriography: Provides anatomic information for location of disease (complications of arteriography: hematoma, pseuodaneurysm, contrast allergy, contrast nephropathy)
• Magnetic resonance angiography (MRA): Can delineate arteries without contrast, but overestimates disease
• Neurospinal compression (spinal stenosis)
• Venous claudication
• Aortic coarctation
• Popliteal entrapment
• Popliteal cysts
• Persistent sciatic arteries
• External iliac dysplasias
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