Symptoms of peripheral vascular diseases

Symptoms of Peripheral Arterial disease

Blood flow through the arterial system may be reduced gradually or suddenly, in either large or small vessels. This leads to a range of potential presenting symptoms.

Claudication

Claudication is muscle pain that occurs with exercise. It is often cramping in nature and relieved by rest. Once recovered, the patient is able to exercise again for a similar duration before the cramp recurs. It is caused by chronic stenosis or occlusion in the artery feeding the muscle group: for example, calf pain on walking due to superficial femoral artery occlusion.

Rest pain

Pain occurring at rest reflects more severe ischaemia, either chronic or acute. The distal parts of the limb and foot are most affected, unlike claudication which involves the muscle groups in the calf and thigh. Typically rest pain is aggravated by elevation of the limb. Foot pain is therefore worse at night. The patient may wake to hang the foot out of the bed, or get up and walk around until the foot recovers. The pain is severe and often requires strong analgesics to control it.



Color changes of the limb

Acute arterial occlusion leads to a pale 'white' leg because the vessels in the skin contain little blood. These vessels then dilate and fill slowly with de-oxygenated blood producing a 'mottled blue' discoloration. If the occlusion is acute on chronic there will be some collateral supply: the color change may not be so dramatic and may recover to normal.

In chronic ischaemia the foot will become pale when elevated but is often red when dependent due to reactive hyperaemia. These color changes form the basis of Buerger's test for chronic severe ischaemia.

Sensory motor symptoms

With severe ischaemia patients may describe numbness of the foot or toes. Loss of motor function with weakness or paralysis is seen in severe acute ischaemia.

Change in temperature

The ischaemic limb fails to maintain a normal temperature and becomes cold. Patients may take to wearing thick socks and wrapping the feet in blankets. This does help to warm the limb to some extent and can occasionally be misleading.

Symptoms of Venous disease

Pain

The pain associated with venous insufficiency is often an ache on standing that gets worse as the day progresses. Distended varicose veins may be a focus of pain and tenderness. Inflamed thrombosed veins (thrombophlebitis) are acutely painful, red and tender.

Swelling

Oedema from the ankle extending up the leg is a common symptom in patients with worsening venous insufficiency.