PERIPHERAL ARTERIAL DISEASE Pathology Clinical Features Symptoms

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.

PERIPHERAL ARTERIAL DISEASE

PERIPHERAL ARTERIAL DISEASE Pathology Clinical Features Symptoms

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.