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PAIN2.PALLOR3.PULSELESSNESS4.PARALYSIS5.PARESTHESIA3, 4 and 5 suggest surgical emergency
Clinical PresentationAsymptomatic:Without obvious symptomatic complaint (but usually with a functional impairment).Classic Intermittent Claudication: Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest. “Atypical” leg pain: Lower extremity discomfort that is exertional, but that does not consistently resolve with rest, consistently limit exercise at a reproducible distance
Differential Diagnosis of Intermittent Claudication Intermittent ClaudicationVenous ClaudicationNeurogenic ClaudicationQuality of painCramping"Bursting"Electric shock-likeOnsetGradual, consistentGradual, can be immediateCan be immediate, inconsistentRelieved byStanding stillElevation of legSitting down,bending forwardLocationMuscle groups (buttock, thigh, calf)Whole legPoorly localized,can affect whole legLegs affectedUsually oneUsually oneOften both
Arterial vs Venous symptomsArterialVenousPainIntermittent claudication, may progress to pain at restChronic, dull aching pain which progresses throughout the dayColorPale to dependent rubor, dull to bright reddish colorNormal to cyanoticSkin temperatureTakes on environmental temperature, coolNormalPulsesDiminished to absentNormal but difficult to palpate due to edemaEdemaNot present with isolated PADPresent, can be pitting. Can have weeping of serous fluidTissue changesSkin is shiny with hair loss. Trophic changes in nails, muscle wastingStasis dermatitis with flaky dry and scaly skin. Can have brownish discoloration. Fibrosis with narrowing of the lower legs (“bottle legs”)WoundsOccur distally especially at toes and web spaces. May develop gangrene and tissue lossShallow ulcers on the foot and ankle, usually medially
How is PVD diagnosed?Ankle-Brachial Index Test (ABI)The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing. The index is determined by dividing ankle systolic BP by arm systolic BP.
Calculation of ABITo calculate the ABI:Divide the highest ankle systolic pressure with thehighest brachial pressure for the index.AHA ABI INTERPRETATION:>1.3 Noncompressible arteries1.00-1.29 Normal0.91-0.99 Borderline (equivocal)0.41-0.90 Mild-to-moderate PAD00.00-0.40 Severe PAD(Borrero, 2009)