Vascular Diseases of the Extremities PERIPHERAL ARTERIAL DISEASE ,RISK FACTORS ,Clinical Features Symptoms , Physical signs with Pathology
PERIPHERAL ARTERIAL DISEASE Increased prevalence in patients of :
- condition that causes partial or complete obstruction of the flow of blood to or from the arteries or veins outside the chest.
- Diabetes mellitus
- Hypercholestrolemia .
- Hypertension
- Cigarette smokers Hyperhomocystinemia
Pathology for PERIPHERAL ARTERIAL DISEASE
- Segmental lesions found in large and medium-sized vessels
- Atherosclerotic plaques
- Thinning of the media
- Destruction of muscle and elastic fibers Formation of thrombi.
RISK FACTORS for PERIPHERAL ARTERIAL DISEASE —
- The risk factors that favor the development of peripheral arterial
- Cigarette smoking
- Hypertension
- Diabetes mellitus
- Hyperlipidemia
- Age 40 to 49 with diabetes and at least one other risk factor for atherosclerosis
- Age ≥ 70 years Age 50 to 69 years with a history of smoking or diabetes
- Abnormal lower extremity pulse examination Known atherosclerosis at other sites (eg, coronary, carotid, or renal arterial disease)
- Leg symptoms suggestive of claudication with exertion or ischemic pain at rest
Classification of peripheral arterial disease : Fontaine’s stages and Rutherford’s categories
| Fontaine | Rutherford | |||
| Stage | Clinical | Grade | Category | Clinical |
| I | Asymptomatic | 0 | 0 | Asymptomatic |
| IIa | Mild claudication | I | 1 | Mild claudication |
| IIb | Moderate to severe claudication | I | 2 | Moderate claudication |
| I | 3 | Severe claudication | ||
| III | Ischemic rest pain | II | 4 | Ischemic rest pain |
| IV | Ulceration or gangrene | III | 5 | Minor tissue loss |
| III | 6 | Major tissue loss | ||
Sites of Involvement
- Femoral artery Popliteal artery Abdominal aorta Iliac arteries
- Tibial artery
- Small arteries involved in diabetes mellitus.
Clinical Features Symptoms PERIPHERAL ARTERIAL DISEASE
- Intermittent claudication – Pain, cramps, numbness, fatigue in the muscle.
- occurs during exercise, relieved by rest.
- In Leriche’s syndrome there is aorto-iliac disease with claudication of hips and thigh.
- Calf muscle claudication occurs in femoropopliteal disease.
- Symptoms usually seen in lower extremities. ~ Later, there is rest-pain (pain without exertion) and cold and numb foot and toes.
- Pain may occur with legs horizontal during sleeping and relieved when legs hang down.
PERIPHERAL ARTERIAL DISEASE Physical signs
- Decreased or absent pulses distal to blockage — Bruit over narrowed artery
- Muscle atrophy Hair loss over part
- Thickened nails
- Smooth, shiny skin
- Cold skin
- Pallor
- Cyanosis
- Ulcers or gangrene
- On elevation of legs, there is pallor
- In the dependent position, legs look red or flushed
- Edema of the legs
- Ischemic neuritis.