Focused History Components for Peripheral Vascular Disease
A comprehensive focused history for peripheral vascular disease (PAD) should include assessment of symptoms, risk factors, comorbidities, and functional impact to guide appropriate management and reduce morbidity and mortality. 1
Symptom Assessment
Claudication and Walking Impairment
- Pain characteristics: Assess for aching, burning, cramping, discomfort, or fatigue 1, 2
- Location: Document specific sites (buttock, thigh, calf, ankle, or foot) 1
- Onset/offset pattern: Document walking distance that triggers symptoms, relation to exercise or uphill walking, and time to relief after rest (typically <10 minutes for classic claudication) 1, 2
- Atypical symptoms: Assess for leg weakness, numbness, or fatigue during walking without pain 1
Rest Pain
- Presence of pain at rest localized to lower leg or foot 1
- Association with upright or recumbent positions 1
- Timing (especially nocturnal pain relieved by hanging leg over bed) 2
Skin Changes and Wounds
- History of poorly healing or non-healing wounds of legs or feet 1
- Timeline of wound development and healing progress 1
Risk Factor Assessment
- Smoking history: Current use, pack-years, quit attempts 1, 3
- Diabetes: Duration, control, complications 1, 3
- Dyslipidemia: Previous lipid levels, treatment history 1, 3
- Hypertension: Duration, control, medications 1, 4
- Family history: First-degree relatives with PAD or abdominal aortic aneurysm 1
- Age: Particularly important if ≥65 years or 50-64 years with risk factors 1
Comorbidity Assessment
- Cardiovascular disease: History of coronary artery disease, myocardial infarction, heart failure 1
- Cerebrovascular disease: History of stroke, transient ischemic attack 1
- Renal disease: Chronic kidney disease history and stage 1
- Erectile dysfunction: Often associated with vascular disease 1
Previous Interventions and Treatments
- Previous vascular procedures: Endovascular interventions, bypass surgeries 1
- Current medications: Antiplatelet agents, statins, antihypertensives 5
- Exercise therapy: Previous participation in supervised exercise programs 5
Functional Assessment
- Impact on daily activities: Ability to perform routine tasks 1
- Walking limitations: Maximum walking distance before symptoms 1, 2
- Quality of life impact: How symptoms affect overall quality of life 1
Acute Limb Ischemia Assessment
For patients with suspected acute limb ischemia, assess for the "6 Ps" 2:
- Pain (sudden onset)
- Pallor
- Pulselessness
- Poikilothermia (coolness)
- Paresthesias
- Paralysis (potential)
Differential Diagnosis Considerations
- Pseudoclaudication: Assess for symptoms suggesting spinal stenosis, arthritis, or venous disease 2
- Postprandial abdominal pain: May suggest mesenteric ischemia, especially if associated with weight loss 1
Common Pitfalls to Avoid
- Failing to distinguish vascular claudication from pseudoclaudication (neurogenic, venous, or musculoskeletal causes) 2
- Missing atypical presentations in patients with diabetes and neuropathy 2
- Overlooking PAD in asymptomatic patients with risk factors 2
- Focusing only on leg symptoms while missing systemic cardiovascular risk 2
By systematically addressing these components in the focused history, clinicians can better identify patients with PAD, assess disease severity, and develop appropriate management strategies to reduce morbidity and mortality.