chapter  46
Peripheral Vascular Disease
Pages 9

CLAUDICATION The clinical presentation of lower extremity arterial occlusive disease is variable, and includes asymptomatic patients (or patients with atypical symptoms), intermittent claudication, and critical limb ischemia (rest pain, ulceration, gangrene).The degree of functional limitation varies depending on the degree of arterial stenosis, collateral circulation, exercise capacity, and comorbid conditions.The discomfort of intermittent claudication (aching, cramping, or tightness) is always exerciseinduced, may involve one or both legs, and occurs at a fairly constant walking distance. Relief is obtained by standing still. Supine ankle:brachial systolic pressure indices (ABI) before and after treadmill exercise testing can confirm the diagnosis (Table 1). Furthermore, a low ABI is associated with an increased risk of stroke, cardiovascular death, and all-cause mortality.