What are the symptoms of peripheral vascular disease?

Symptoms of Peripheral Vascular Disease

The primary symptoms of peripheral vascular disease include intermittent claudication (pain, aching, cramping, or fatigue in leg muscles during walking that resolves within 10 minutes of rest), ischemic rest pain, nonhealing wounds/ulcers, and in severe cases, gangrene. 1

Clinical Presentation by Disease Severity

Asymptomatic PAD

• Many patients (20-59%) with objectively proven PAD report no leg symptoms 1
• These patients often self-limit their activity to remain below their ischemic threshold
• Despite lack of symptoms, these patients have functional impairment comparable to those with claudication 1

Chronic Symptomatic PAD (Claudication)

• Classic claudication symptoms:

  • Pain, aching, cramping, or tired/fatigued feeling in the buttocks, thigh, calf, or foot 1
  • Occurs consistently during walking/exertion
  • Does not start at rest
  • Does not improve during walking
  • Resolves within approximately 10 minutes of rest 1

• Additional symptom descriptors:

  • Tingling, numbness, burning, throbbing, or shooting pain 1
  • Exertional leg fatigue or weakness 1
  • Inability to walk at normal pace 1

• Location of symptoms often correlates with the site of arterial stenosis:

  • Iliac artery disease: hip, buttock, thigh, and calf pain 2
  • Femoral/popliteal artery disease: primarily calf pain 2
  • Tibial artery disease: calf pain or foot pain and numbness 2

Chronic Limb-Threatening Ischemia (CLTI)

• Ischemic rest pain (typically affecting the forefoot)
  • Worsened with limb elevation
  • Relieved by dependency (hanging leg down) 1
• Nonhealing wounds or ulcers
• Gangrene
• Symptoms present for more than 2 weeks 1

Acute Limb Ischemia (ALI)

• Sudden decrease in arterial perfusion threatening limb viability
• Classic "6 Ps" of acute limb ischemia:
  • Pain (sudden, severe)
  • Pallor (pale skin)
  • Pulselessness
  • Poikilothermia (coolness)
  • Paresthesias (numbness/tingling)
  • Paralysis (in advanced cases) 1
• Symptoms develop acutely (less than 2 weeks duration) 1

Physical Examination Findings

• Pulse abnormalities: Diminished or absent pulses in the affected limb 1
• Skin changes:
  • Dependent rubor (redness when leg is dependent)
  • Pallor when foot is elevated
  • Absence of hair growth
  • Dystrophic toenails 1
  • Trophic skin changes
  • Distal hair loss
  • Hypertrophic nails 1
• Temperature: Cool skin compared to the unaffected limb 1
• Wounds: Presence of ulcerations or gangrene, particularly on pressure points or distal aspects of the limb 1

Diagnostic Considerations

• Symptoms may be atypical in patients with diabetes and peripheral neuropathy 1
• Vascular claudication must be distinguished from pseudoclaudication (spinal stenosis, arthritis, chronic compartment syndrome) 2
• The ankle-brachial index (ABI ≤0.9) is the primary diagnostic tool for confirming PAD 1, 2

Common Pitfalls

• Misdiagnosis of claudication with pseudoclaudication 2
• Underestimating cardiovascular risk in patients with PAD 2
• Focusing only on leg symptoms while neglecting overall cardiovascular risk 2
• Overlooking PAD in patients with atypical symptoms, especially those with diabetes and neuropathy 1

Recognizing the symptoms of peripheral vascular disease is crucial for early diagnosis and treatment, as PAD is associated with significant morbidity, mortality, and decreased quality of life. Prompt diagnosis allows for appropriate management to improve symptoms and reduce cardiovascular risk.