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How many patients are asymptomatic?
Up to 20–50% of patients with PAD are asymptomatic.
Describe intermittent claudication.
Seen in approx. 10–35% of patients
Pain, cramps, or paresthesia distal to arterial occlusion
Femoropopliteal disease (most common): typically causes calf claudication
Aortoiliac disease (Leriche syndrome)
Level of the aortic bifurcation or bilateral occlusion of the iliac arteries
Triad of bilateral buttock, hip, or thigh claudication, erectile dysfunction, and absent/diminished femoral pulses
Tibiofibular disease: typically causes foot claudication
Worsens upon exertion ,
Completely relieved by rest or lowering affected limbs
Reproducible on asking the patient to walk the same distance at which symptoms typically occur
Describe rest pain.
Rest pain occurs as disease progresses and indicates severe ischemia.
Typically occurs first in the toes and forefoot
Worsens with reclining (e.g., while sleeping)
Improves on hanging feet off the bed or on standing
Describe critical limb ischemia.
Indicative of limb-threatening arterial occlusion
Characterized by the presence of any one of the following:
Rest pain lasting ≥ 2 weeks
Nonhealing ulcers
Tissue loss (gangrene)
List examination findings.
Trophic changes
↓ Skin temperature, ↓ perspiration
↓ Hair on legs, ↓ nail growth, brittle nails
Atrophied muscles
Dry atrophic, shiny skin and/or bluish skin discoloration
Livedo reticularis (advanced disease)
Gangrene, ulcers, necrosis (end-stage disease): See also “Arterial ulcer.”
Absent or diminished pulses: examine distal pulses bilaterally, including
Upper extremity: brachial artery, radial artery
Lower extremity: femoral artery , popliteal artery , posterior tibial artery , and dorsalis pedis artery
Buerger sign [4][5]
With the patient in the supine position, elevate the lower limbs to a 45° angle at the hip.
Evaluate for pallor of the feet.
Ask the patient to sit up with their legs off of the examination table in the dependent position.
Evaluate the time taken for the color to return to the feet and for the veins to become distended.
Positive Buerger sign
Skin pallor on limb elevation
Reactive hyperemia on limb dependency
A venous filling time of > 20 seconds may indicate advanced ischemia.
Bruit: over the affected artery may be heard in > 60–70% of cases with PAD
Last changed2 years ago