Bonveda's Blog

The object of the vascular history is to determine whether the patient has a disorder of the arterial, venous, or lymphatic system. A history of intermittent claudication of the upper or lower extremity is suggested by the presence of crampy pain with a fixed degree of exertion, such as walking two blocks. The discomfort is located just distal to the level of the arterial occlusion thus, calf cramps suggest disease in the superficial femoral artery. Cramps in the absence of exertion are not likely to be vascular in etiology. More severe degrees of ischemia result in rest pain, characteristically affecting the toes or instep and relieved by dependency. The sudden onset of pain is suggestive of acute arterial occlusion. True ischemic rest pain must be distinguished from other pain syndromes, such as diabetic neuropathy, in which the patient typically experiences burning on the plantar surface of the foot. Finally, the patient should be questioned regarding the presence of nonhealing sores or ulcers and the location of these lesions determined; lesions of the toes and feet suggest arterial disease, whereas perimalleolar lesions suggest a venous etiology. If aneurismal disease is suspected, the patient should be questioned for a history of abdominal, back, and flank pain, as well as the presence of “ blue toes” suggestive of embolic events.
Symptoms of atherosclerotic cerebrovascular disease include the classic hemispheric complaints of transient monocular blindness, hemiparesis or hemiparesthesia, dysphasia, and dysarthria, as well as nonhemispheric symptoms such as blurred vision, ataxia, and syncope.
Patients with venous disorders may present with acute or chronic complaints. The sudden onset of pain, swelling, and cyanosis of an extremity is highly suggestive of deep venous thrombosis. Patients with varicose veins should be questioned regarding the presence of pain, rupture, and superficial phlebitis. Chronic venous insufficiency is characterized by skin pigmentation, edema, and chronic ulceration.
Physical examination of the patient with vascular disease begins with observation of the skin, nothing the presence of pallor, dependent rubor, and digital ulceration suggestive of arterial disease, as well as cyanosis, pigmentation, swelling, and malleolar ulceration suggestive of venous disorders. Isolated painful blue toes indicate an embolic process.
Auscultation for bruits over the aorta and its major branches may suggest areas of disease
but are not diagnostic of the presence of all pulses, which should be graded from 1+ to 4+,
indicating a diminished to-aneurysmal quality. Aneurysms of the aorta and popliteal arteries are detected by palpation of the epigastrium and popliteal fossa, respectively.