Peripheral vascular

ALI vs PAD vs DVT vs CVI

• ID
• cc: leg pain +/- swelling
• HPI
  • Acute limb ischemia
    • Symptom duration < 2 weeks
    • usually single limb
    • 6 Ps: Pain, Pallor, Polar, Pulselessness, Parethesia, Paralysis
    • Rest / night pain
  • PAD
    • Claudication:
      • pain with exertion (calves or other exercising mucle group)
      • relieved by short rest
      • Reproducible pain over same distance; same location; same amount of rest to relieve
    • often bilateral
  • DVT
    • Unilateral leg edema
    • Erythema
    • Warmth
    • Tenderness
  • Chronic venous insufficiency
    • Diffuse aching
    • fullness/tightness
    • Usually bilateral
    • better in morning, worsens as day progresses
• Associated symptoms
  • Acute limb ischemia
    • Palpitations (AFib)
  • PAD
    • Ulcer
      • Distal, on plantar surface of foot of toes
    • Hair loss, hypertrophic nails, shiny skin, atrophic muscle
  • DVT
    • Respiratory symptoms (SOB, hemoptysis, cough, pleuritic chest pain)
  • Chronic venous insufficiency
    • Lower third of leg (Gaiter region)
• Risk factors
  • Acute limb ischemia
    • Pro-embolic states (Afib, endocarditis, aneurysms)
    • Hypercoagulable states - congenital or acquired
    • Cardiovascular RFs (Smoking, DM, HTN, dyslipidemia, FHx of CAD/CVD)
  • PAD
    • Cardiovascular RFs
  • DVT
    • Previous DVT
    • Obesity
    • Older age
    • female
    • Pregnancy
    • Previous leg injury
    • prolonged immobilization (travel)
    • History of cancer and treatment
    • History of blood clotting disorders
    • trauma
  • Chronic venous insufficiency
    • Obesity
    • Older age
    • female
    • Prednancy
    • Previous leg injury
    • Increased time standing (occupational)
• Medications
• Allergies
• Past Medical History
• Habits
• FIFE

AAA

• ID
• cc: Tender abdomen, large periumbilical pulsatile mass, low BP
• HPI
  • Duration of symptoms
  • Sudden onset of severe abdo / back pain
  • Family history of AAA
• Associated symptoms
  • pulsatile mass
  • Hypotension
  • Tender abdo / back pain
• Risk factors
  • Hyperhomocysteinemia
  • Smoking (current or ever)
  • Hernia
  • age
  • male
  • family hx of AAA
  • Cardiovascular RFs
• Medications
• Allergies
• Past Medical History
• Habits
• FIFE