Diagnosis and management of peripheral vascular disease - Tips from Other Journals

Date: June, 1992

Atherosclerotic peripheral vascular disease causes symptomatic disability in 1 million persons in the United States each year. More than 5 percent of persons over 70 years of age are affected. In addition to functional impairment and the potential for limb loss, atherosclerotic peripheral vascular disease is associated with a significant increase in mortality risk. Wilt reviews current strategies in the diagnosis and management of atherosclerotic peripheral vascular disease.

The classic symptom of atherosclerotic peripheral vascular disease is intermittent claudication, pain in a lower extremity muscle that is precipitated by exertion and relieved by rest (see table on clinical indicators). In termittent claudication may be confused with other similar syndromes (see table on differential diagnosis). These syndromes may be distinguished from atherosclerotic peripheral vascular disease by the location and duration of pain and the precipitating factors.

Clinical Indicatorsof Peripheral Vascular DiseaseDiminished pulsesArterial bruitsAtrophic skin with hair lossBrittle nailsTissue ulcerationGangreneDependent ruborElevation pallorFrom Wilt TJ. Current strategies in the diagnosisand management of lower extremity peripheralvascular disease. J Gen Intern Med 1992; 7:87-101.Used with permission.Differential Diagnosis of Intermittent ClaudicationArthritisProlapsed intervertebral diskSpinal stenosis (pseudoclaudication)Peripheral neuropathiesRestless leg syndromeDeep venous thrombosisArterial embolusThromboangiitis obliterans (Buerger's disease)From Wilt TJ. Current strategies in the diagnosis and management of lowerextremity peripheral vascular disease. J Gen Intern Med 1992; 7:87-101. Usedwith permission.

Medical management of atherosclerotic peripheral vascular disease should address risk factors such as smoking that contribute to disease progression. Concurrent diseases, such as diabetes and hypertension, should be vigorously managed. Local measures, including foot care, should be emphasized. The role of medications in treatment is controversial and is still under investigation.

Indications for consideration of interventional therapy (bypass surgery or percutaneous transluminal angioplasty) include symptoms that interfere with the patient's lifestyle, failure to respond to medical interventions, development of ischemic pain at rest and skin ulceration or gangrene. Potential surgical candidates should undergo noninvasive vascular testing to determine the location and severity of the disease.

Careful medical management is the key to long-term success in the care of patients with atherosclerotic peripheral vascular disease. (Journal of General Internal Medicine, January/February 1992, vol. 7, p. 87.)

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