10
Diagnosis
2.2. History and Physical Examination to Assess for PAD
COR LOE
Recommendations
1 B-NR
1. In patients at increased risk of PAD (Table 5), a
comprehensive medical history and review of symptoms to
assess for exertional leg symptoms, lower extremity rest pain,
and lower extremity wounds or other ischemic skin changes
should be performed.
1 B-NR
2. In patients at increased risk of PAD (Table 5), a
comprehensive vascular examination and inspection of the
legs and feet should be performed regularly (Table 6).
Table 4. Clinical Subsets of Patients With PAD
Clinical
Subset Description/Characterization
ALI • Severe clinical subset of PAD.
• In a contemporary RCT of patients with symptomatic PAD who
were observed for a mean of 30 mo, the incidence of ALI was 1.7%, or
0.8/100 patient-years. Previous lower extremity revascularization, atrial
fibrillation, lower ABI values associated with increased risk of ALI in
this population.
• Sudden decrease in arterial perfusion of the leg that threatens the
viability of the limb.
• Acute clinical symptoms (<2 wk duration) include pain, pallor,
pulselessness, poikilothermia (coolness), paresthesias, and potential for
paralysis.
• Causes of ALI include embolism, thrombosis within native artery or
at site of previous revascularization (graft or stent), trauma, peripheral
aneurysm with distal embolization, or thrombosis (Table 20).
• Timing of presentation may vary depending on the underlying etiology.
• The status of the leg in ALI is further classified according to the
Rutherford classification system.
▶ Class I. Viable (limb not immediately threatened)—No sensory
loss; no motor loss; audible arterial and venous Doppler signals.
▶ Class IIa. Salvageable/marginally threatened (limb salvageable
if promptly treated)—Mild-to-moderate sensory loss (limited
to toes) but no motor loss, often inaudible arterial Doppler but
audible venous Doppler signals.
▶ Class IIb. Salvageable/immediately threatened (limb salvageable
if urgently treated)—Sensory loss involving more than the toes;
mild-moderate motor weakness. Inaudible arterial but audible
venous Doppler signals.
▶ Class III. Irreversible (major tissue loss or permanent nerve
damage inevitable)—Complete sensory loss (anesthetic);
complete loss of motor function (paralysis); inaudible arterial and
venous Doppler signals.
(cont'd)
