Chronic PVD History: °°" 4. INTERMITTENT CLAUDICATION * Derived from the Latin word ‘to limp’ + “Reproducible pain on exercise which is relieved by rest” + Pain can also be reproduced by elevating the leg + “my legs get sore at night and feel better when | hang them over the edge of the bed” . Other Symptom/Signs: + Aburning or aching pain in the feet (especially at night) + Cold skin/feet + Increased occurrence of infection Non-healing Ulcers Asymptomatic Critical Stenosis = >60%, impending acute ischemic limb: - rest pain - ischemic ulceration > gangrenefot 30% Buttock & Hip Claudication lliac Impotence ~Leriche's Syndrome. pas Common SEA oisuaican p femoral “~~ Thigh Clauaication femoral ‘Superficial — _ 9 Upper 2/3 Calf Claudication femoral Popliteal —_—— Loner 1/3 Cait Claudication Anterior tibial Posterior Peroneal tibial <~ Foot Claudieation Dorsalis pedis Pedal arch. PERIPHERAL VASCULAR DISEASE (PVD) Location 05 PAIN Aererx wwvowwed WPS Aorta Burrocks Tuac common, THIGH FEMORAL er 4h ‘superficial ier FemorAr " wet PoruiteaL TiBiALPhysical Examination: What do to: Loc Inspection Expose the skin and look for: Palpation Auscultation Ankle Brachial Index (ABI) Buerger’s Test Thick Shiny Skin Hair Loss Brittle Nails Colour Changes (pallor) Ulcers Muscle Wasting Temperature (cool, bilateral/unilateral) Pulses: ?Regular, 7AAA Capillary Refill Sensation/Movement Femoral Bruits Systolic BP in ankle ‘Systolic BP in brachial artery Elevate the leg to 45° - and look for pallor Place the leg in a dependent position 90°& look for a red flushed foot before returning to normal Pallor at <20° = severe PAD,