Peripheral arterial disease history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with [[peripheral arterial disease]] can be asymptomatic, can have symptoms of [[intermittent claudication]] or can sometimes have critical symptoms that include ulceration and [[gangrene]]. The clinical presentation of peripheral arterial disease depends on the location and severity of stenosis of the vessel. The symptoms range from mild [[pain]] on exertion to severe [[ischemia]]. The patient presents with symptoms of claudication: intermittent leg cramping pain that is induced by exercise and relieved by rest. | Patients with [[peripheral arterial disease]] can be asymptomatic in 70% of cases, can have symptoms of [[intermittent claudication]] or can sometimes have critical symptoms that include ulceration and [[gangrene]]. The clinical presentation of peripheral arterial disease depends on the location and severity of stenosis of the vessel. The symptoms range from mild [[pain]] on exertion to severe [[ischemia]]. The patient presents with symptoms of claudication: intermittent leg cramping pain that is induced by exercise and relieved by rest. | ||
==History and Symptoms== | ==History and Symptoms== | ||
Revision as of 01:01, 31 October 2012
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Peripheral arterial disease Microchapters |
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Differentiating Peripheral arterial disease from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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AHA/ACC Guidelines on Management of Lower Extremity PAD |
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Guidelines for Structured Exercise Therapy for Lower Extremity PAD |
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Guidelines for Minimizing Tissue Loss in Lower Extremity PAD |
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Guidelines for Revascularization of Claudication in Lower Extremity PAD |
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Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD |
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Guidelines for Longitudinal Follow-up for Lower Extremity PAD |
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Peripheral arterial disease history and symptoms On the Web |
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American Roentgen Ray Society Images of Peripheral arterial disease history and symptoms |
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Peripheral arterial disease history and symptoms in the news |
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Directions to Hospitals Treating Peripheral arterial disease |
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Risk calculators and risk factors for Peripheral arterial disease history and symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Rim Halaby
Overview
Patients with peripheral arterial disease can be asymptomatic in 70% of cases, can have symptoms of intermittent claudication or can sometimes have critical symptoms that include ulceration and gangrene. The clinical presentation of peripheral arterial disease depends on the location and severity of stenosis of the vessel. The symptoms range from mild pain on exertion to severe ischemia. The patient presents with symptoms of claudication: intermittent leg cramping pain that is induced by exercise and relieved by rest.
History and Symptoms
History
An accurate history is the key to the diagnosis of PAD. The history must include information about:
- Any exertional limitation of the lower extremity muscles or any history of walking impairment (fatigue, numbness, aching, or pain)
- Detailed description of the pain: location, onset, progression, relieving and aggravating factors
- Any pain at rest localized at the lower leg or foot and its association with the upright or recumbent positions
- Atherosclerotic risk factors: The atheroscolotic risk factors may help to identify patients, who although asymptomatic, have evidence of PAD on physical examination or noninvasive testing
- Any poorly healing or non healing ulcers of the legs or feet
- Postprandial abdominal pain that reproducibly is provoked by eating and is associated with weight loss
- Family history of a first-degree relative with Abdominal Aortic Aneurysm
Symptoms
No symptoms or atypical symptoms (70% of cases)
Intermittent claudication
- Onset: always after walking or exercise
- Character: cramping
- Site: unilateral or bilateral
- Walking distance for the symptoms to start: almost constant
- Relief: Rest and standing without movement
Critical limb ischemia
- Rest pain
- Ulceration
- Gangrene
Acute arterial occlusion
- Pain
- Pallor
- Paraesthesias
- Paralysis
- Pulselessness
2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)-Recommendations - Vascular History and Physical Examination (DO NOT EDIT)[1]
| Class I |
| "1. Individuals at risk for lower extremity PAD (see Section 2.1.1, Table 2) should undergo a vascular review of symptoms to assess walking impairment, claudication, ischemic rest pain, and/or the presence of nonhealing wounds. (Level of Evidence: C)" |
| "2. Individuals at risk for lower extremity PAD (see Section 2.1.1) should undergo comprehensive pulse examination and inspection of the feet. (Level of Evidence: C)" |
| "3. Individuals over 50 years of age should be asked if they have a family history of a first-order relative with an abdominal aortic aneurysm. (Level of Evidence: C)" |
2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)-Recommendations for Claudication in PAD Patients (DO NOT EDIT)[1]
| Class I |
| "1. Patients with symptoms of intermittent claudication should undergo a vascular physical examination, including measurement of the ABI. (Level of Evidence: B)" |
| "2. In patients with symptoms of intermittent claudication, the ABI should be measured after exercise if the resting index is normal. (Level of Evidence: B)" |
| "3. Patients with intermittent claudication should have significant functional impairment with a reasonable likelihood of symptomatic improvement and absence of other disease that would comparably limit exercise even if the claudication was improved (e.g., angina, heart failure, chronic respiratory disease, or orthopedic limitations) before undergoing an evaluation for revascularization. (Level of Evidence: C)" |
| "4. Individuals with intermittent claudication who are offered the option of endovascular or surgical therapies should:(a) be provided information regarding supervised claudication exercise therapy and pharmacotherapy;(b) receive comprehensive risk factor modification and antiplatelet therapy;(c) have a significant disability, either being unable to perform normal work or having serious impairment of other activities important to the patient; and (d) have lower extremity PAD lesion anatomy such that the revascularization procedure would have low risk and a high probability of initial and long-term success. (Level of Evidence: C)" |
| Class III |
| "1. Arterial imaging is not indicated for patients with a normal postexercise ABI. This does not apply if other atherosclerotic causes (e.g., entrapment syndromes or isolated internal iliac artery occlusive disease) are suspected. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2012-10-09. Unknown parameter
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