P1: SBT
0521779407-04a CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:48
180 Atherosclerotic Occlusive Disease
weakness or numbness of arm or leg
dysarthria, aphasia
■Visceral (mesenteric)
➣Intestinal angina: Post-prandial abdominal pain, occurs 20 min-
utes after ingestion and resolves after several hours
➣Weight loss+fear of food
■Renal
➣Ischemic nephropathy (elevated creatinine)
➣Hypertension (poorly controlled by medication)
■Extremity
➣Claudication
Aching pain usually in upper calf reproducibly induced by
exercise; never present at rest
Relieved by rest while standing (does not require sitting for
relief )
Can radiate to buttocks and thighs with proximal (iliac) disease
Can occur in arm with subclavian stenosis
➣Impotence
Suggests aorto-iliac occlusive disease
➣Limb threat
Rest pain
Burning pain across ball of foot
awakens patient at night
relieved by dangling leg from bed or walking
does NOT radiate into calf or leg
NEVER starts in knee or upper leg
Gangrene
Non-healing arterial ulcers
Usually on distal aspects of foot
very tender
■Embolism
➣“Blue toe” syndrome
■Carotid Bruit
➣Associated (40%) with carotid stenosis
➣Often not present with critical carotid stenosis
■Abdominal bruit
➣Suggestive of mesenteric or renal stenosis
■Peripheral pulses
➣Usually decreased in most patients with symptomatic occlusive
leg disease
➣Palpable pedal pulses may be present