By :Dr.

Usama El baz

Perfipheral arterial disease

 personal hx:
1. Name
2. Age:
Adults:burger's &raynaud's disease
Elderly: atherosclerosis
3. Sex
M :burger's& atherosclerosis
F :raynaud's
4. Residence&nationality
Raynauds in cold countries
Burger's in jews
5. Occupation:
Vibrating instruments raynaud's phenomenon
6. Marital status :
Impotence with leriche $
7. Special habits :
Smoking burger's d & atherosclerosis
 Complaint
1. pain
a) Pain on waking(claudication)
b) Rest pain

2.gangrene

3.Trophic changes

 Present hx
1. sym of limb ischemia
a) Pain
In chronic ischemia ,it may be one of two types
1. intermittent claudications ( due to muscle ischemia)
-onset, course & duration :it is usually gradual with long duration & slowly
progressive course
- character :cramp like on waking
- Site : depends on the site of arterial obstruction.
Aortoiliac occlusion pain in thigh and gluteal region
Femoropopliteal occ.  ==calf
Tibial occ.  ==sole
 -severity :
Boyd's classification:
Grade I :claudication passes of on continued walking ( as metabolites cause
vasodilation and incr blood flow)
Grade II :pain persist but does not force the pt. to stop
GradeIII: force the pt. to stop

-aggravating and relieving factors :

Pain increases on walking and decreases on rest

-relation to temp:

In raynaude's d cold incr the pain while warm decr it

Claudication distance = the distance after which the pain felt

Distance less than 50 m= critical ischemia

Claudication time =time after which pain is felt

Period of rest after claudication = time after stop of

walking after which pain is relieved

2. rest pain : (due to nerve ischemia)

It is continuous severe burning pain in the foot. aggravated by elevation

or warmth (at night)& relieved by lowering and uncovering the limb

b) trophic changes :
-loss of hair
- brittle nails
Dry scaly skin
-interdigital fungal infection (tinea pedis )and callosities .
-tapering digits (loss of subcutaneous fat )& muscle wasting
Ulceration
C) sensory changes :
Paraesthesia (tingling and numbness)
Hypo & hyperesthesia occur @ time of claudication (due to shunting of blood
from skin to muscles )
Anaesthesia : in acute ischemia
D) coldness : of affected part
E) colour changes
Pallor, cyanosis & black discoloration
 F) functional changes
 Motor disturbances:
Weakness & wasting in chronic ischemia
Paralysis in acute ischemia
 Sexual disturbances :
Impotence occurs in aortic and common iliac occlusion( le riche
$)
G) gangrene :
- onset, course & duration
- relation to trauma ( in senile gangrene )
-site & extent :
Which limb ?
Unilateral or bilateral ?
2. symp of organ ischemia :
 Heart : angina & infarction
 Brain : stroke ,TIAs
 Kidney : pain ,renal troubles, hematuria & HTN
 Intestine :postprandial intestinal angina , bloody diarrhea
3. fever :in septic moist gangrene
4. trauma :
Senile gangrene may follow minor trauma e.g . trimming of nails
Traumatic gangrene (from injury of vessels
5. hx of DM or HTN ( usually included with present hx)
 Past hx
- Similar attacks
- Previous treatment for the same condition
- Heart & liver ds
 Family hx
- Atherosclerosis
- DM& HTN
- Raynaud's d
- Burger's d