The Extremities and Peripheral Vascular System

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Chapter 22 The Extremities and Peripheral Vascular Exam

B. The Peripheral Arteries

(2) Raynaud’s Phenomenon

(3) Allen’s Test

(4) Peripheral Vascular Disease

16 What are the symptoms of PVD?

Mostly symptoms of arterial insufficiency, such as exertional limb weakness, resting limb pain (or paresthesia), and poor healing of sores or ulcerations. The classic symptom, however, is claudication (from the Latin term for limping)—i.e., intermittent limb pain, usually triggered by activity. This affects different parts of the lower extremity, depending on which artery is compromised. Yet, whether obstruction is high or low, both pedal pulses are absent in PVD, an important diagnostic clue (see Table 22-1).

Table 22-1 Symptoms of Peripheral Vascular Disease

Above the Knee Below the Knee
PVD of the distal aorta (from below the renal arteries to the common iliacs) will cause claudication of the buttocks, thigh, and calf. It may even compromise erection. Given its high location, all lower extremity pulses will be lost. Peroneotibial PVD will cause either no symptoms or foot claudication. Only pedal pulses are lost. Except for patients with diabetes and thromboangiitis obliterans, this is the least common form of the disease.
Femoropopliteal  
PVD will cause calf claudication. Femoral pulses are present, but those beyond are absent.  

18 Can these findings predict severity of the disease?

No. Vascular bruits and other signs only indicate presence of disease; they do not correlate with severity. For severity, the standard assessment is the ankle-to-arm systolic pressure index (see Chapter 2, questions 117–119). Still, in diabetic patients with significantly abnormal ankle–brachial indexes, the following symptoms/signs predict more severe disease: (1) age greater than 65, (2) history of peripheral vascular disease or claudication in less than one block, (3) diminished foot pulses, and (4) venous filling time longer than 20 seconds.