What are the typical physical manifestations in the legs of a patient with Peripheral Arterial Occlusive Disease (PAOD)?

From the Guidelines

Patients with Peripheral Arterial Occlusive Disease (PAOD) typically present with several characteristic physical manifestations in their legs, including skin pallor, dependent rubor, thin and shiny skin, hairlessness, and thickened toenails, as well as diminished or absent pulses in the lower extremities, which are associated with reduced blood flow and increased risk of morbidity and mortality 1. The physical examination of a patient with PAOD may reveal a range of signs, including:

• Skin pallor or paleness, particularly when the leg is elevated
• Dependent rubor, a reddish-purple discoloration caused by blood pooling in dilated vessels
• Thin, shiny, and hairless skin
• Thickened toenails due to chronic poor circulation
• Temperature differences, with affected limbs feeling cooler to touch compared to unaffected areas
• Diminished or absent pulses in the dorsalis pedis, posterior tibial, popliteal, or femoral arteries Advanced disease can lead to:
• Muscle atrophy
• Ulcerations, particularly on pressure points like toes, heels, or ankle areas
• Gangrene in severe cases These manifestations result from atherosclerotic narrowing of peripheral arteries, reducing blood flow to tissues and causing ischemic changes, which can significantly impact the patient's quality of life and increase the risk of morbidity and mortality 1. It is essential to note that the severity of these findings generally correlates with the degree of arterial obstruction and the chronicity of the disease process, highlighting the importance of early diagnosis and treatment to prevent progression and improve outcomes 1.

From the Research

Physical Manifestations in the Legs of a Patient with PAOD

The typical physical manifestations in the legs of a patient with Peripheral Arterial Occlusive Disease (PAOD) can be described as follows:

• Decreased skin blood flow and perfusion, leading to pale or cool skin 2, 3
• Hair loss and thinning of the skin on the affected leg 4
• Decreased nail growth and thickening of the nails 4
• Presence of ulcers or wounds that are slow to heal, particularly on the feet and toes 3, 5
• Edema or swelling in the affected leg, particularly in the calf and foot 3
• Decreased or absent pulses in the feet and ankles 4, 5
• Pain or cramping in the legs, particularly during walking or exercise, known as intermittent claudication 4, 5
• Weakness or fatigue in the legs 4, 5

Skin Microcirculation and Leg Dependency

Studies have shown that patients with PAOD have a disturbed reactivity of the skin microcirculation in the ischemic foot 2. The skin microcirculation is also affected by leg dependency, with a shift of blood flow from proximal to distal skin regions during leg dependency 3. This shift in blood flow may contribute to the improved blood supply of ischemic skin regions during leg dependency.

Graft Patency and Limb Salvage

The use of antiplatelet agents, such as aspirin or clopidogrel, has been shown to improve graft patency and limb salvage rates in patients with PAOD who have undergone peripheral arterial bypass surgery 6. However, the evidence for the use of these agents is limited, and further studies are needed to fully understand their effects.