RSS-Feed abonnieren
DOI: 10.1055/s-0034-1393964
Clinical Assessment of Patients with Peripheral Arterial Disease
Publikationsverlauf
Publikationsdatum:
14. November 2014 (online)
![](https://www.thieme-connect.de/media/sir/201404/lookinside/thumbnails/10.1055-s-0034-1393964-1.jpg)
Abstract
Peripheral arterial disease (PAD) describes the clinical manifestations of atherosclerosis affecting the circulation in the legs. The severity of PAD is classified according to symptom severity, time course, and anatomical distribution. The signs and symptoms of PAD reflect the degree of circulatory compromise and whether there has been a gradual reduction in the circulation or an abrupt, uncompensated decrease. Accurate clinical assessment underpins decisions on management strategy and should objectively assess the severity of the ischemia and need for revascularization. Clinical history should discriminate symptoms of PAD from other conditions presenting with leg pain, elucidate cardiovascular risk factors and the effect of symptoms on the patient's quality of life. Clinical examination includes signs of general cardiovascular disease and associated conditions before assessing the circulation and viability of the limb. Palpation of peripheral pulses must be augmented by determination of the ankle brachial pressure index using hand held Doppler. A whole patient approach to management is required and must include modification of cardiovascular risk status as well as dealing with the local circulatory manifestation of PAD.
-
References
- 1 National Institute for Health and Care Excellence. Lower Limb Peripheral Arterial Disease: Diagnosis and Management CG147. London: National Institute for Health and Care Excellence; 2012
- 2 Heald CL, Fowkes FG, Murray GD, Price JF ; Ankle Brachial Index Collaboration. Risk of mortality and CVD associated with the ankle-brachial index: systematic review. Atherosclerosis 2006; 189: 61-69
- 3 Fowkes FG, Murray GD, Butcher I , et al; Ankle Brachial Index Collaboration. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008; 300 (2) 197-208
- 4 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG ; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 (Suppl S): S5-S67
- 5 Welten GM, Schouten O, Chonchol M , et al. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50 (1) 109-121
- 6 Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease?. JAMA 2006; 295 (5) 536-546
- 7 Anderson B, Kelly AM, Kerr D, Clooney M, Jolley D. Impact of patient and environmental factors on capillary refill time in adults. Am J Emerg Med 2008; 26 (1) 62-65
- 8 Boulton AJ, Armstrong DG, Albert SF , et al; American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31 (8) 1679-1685
- 9 Lange SF, Trampisch HJ, Pittrow D , et al; getABI Study Group. Profound influence of different methods for determination of the ankle brachial index on the prevalence estimate of peripheral arterial disease. BMC Public Health 2007; 7: 147
- 10 Roedersheimer LR, Feins R, Green RM. Doppler evaluation of the pedal arch. Am J Surg 1981; 142 (5) 601-604
- 11 Attinger CE, Meyr AJ, Fitzgerald S, Steinberg JS. Preoperative Doppler assessment for transmetatarsal amputation. J Foot Ankle Surg 2010; 49 (1) 101-105
- 12 Romanos MT, Raspovic A, Perrin BM. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes. J Foot Ankle Res 2010; 3: 31
- 13 Espinola-Klein C, Rupprecht HJ, Bickel C , et al; AtheroGene Investigators. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation 2008; 118 (9) 961-967
- 14 Gulati S, Coughlin PA, Hatfield J, Chetter IC. Quality of life in patients with lower limb ischemia; revised suggestions for analysis. J Vasc Surg 2009; 49 (1) 122-126
- 15 Mehta T, Venkata Subramaniam A, Chetter I, McCollum P. Disease-specific quality of life assessment in intermittent claudication: review [Review]. Eur J Vasc Endovasc Surg 2003; 25 (3) 202-208
- 16 Liles DR, Kallen MA, Petersen LA, Bush RL. Quality of life and peripheral arterial disease. J Surg Res 2006; 136 (2) 294-301
- 17 Mazari FAK, Carradice D, Rahman MN , et al. An analysis of relationship between quality of life indices and clinical improvement following intervention in patients with intermittent claudication due to femoropopliteal disease. J Vasc Surg 2010; 52 (1) 77-84
- 18 Diehm C, Darius H, Pittrow D , et al. Prognostic value of a low post-exercise ankle brachial index as assessed by primary care physicians. Atherosclerosis 2011; 214 (2) 364-372
- 19 Rutherford RB, Baker JD, Ernst C , et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26 (3) 517-538