Self-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease

Abstract

Two distinctive PAD phenotypes-each with its own characteristics and risk factors-emerged by anatomic lesion location; however, PAD-specific leg symptoms did not always reflect the anatomic lesion location. These findings may open new opportunities to better tailor PAD management to these two PAD subgroups and may raise awareness about not relying on self-reported symptoms to guide further diagnostic imaging and peripheral lesion management.

Methods of symptom evaluation and their impact on peripheral artery disease (PAD) symptom prevalence: A review

“…18,21,22 Higher prevalence has been reported in smaller populations (43.8%) 33 and specific populations including only individuals complaining of leg pain (78.8%), 34 or excluding individuals who have non-compressible arteries, CLI, or a history of revascularization (43.6%). 35 Overall, study results indicate that there are specific characteristics of individuals who are more likely to report classic claudication. Reporting appears to increase as age increases, 21,28,29,36,37 and be more prevalent among men, 21,36,37 and in individuals with diabetes, 21 hypertension, 38 a previous diagnosis of PAD, 2,18 or a more severe form of the disease.…”

“…Reporting appears to increase as age increases, 21,28,29,36,37 and be more prevalent among men, 21,36,37 and in individuals with diabetes, 21 hypertension, 38 a previous diagnosis of PAD, 2,18 or a more severe form of the disease. 18,21,37 Disease location may also influence the reporting of classic claudication, with higher prevalence among those with distal lesions 35 or large vessel PAD. 28 …”

“…38 However, prolonged symptom recovery was also grouped together with pain at rest into a ‘no pain’ category. 47 Pain that presented at rest and on exertion was often referred to as ‘leg pain on exertion and rest,’ 21,39–41,45 but was also referred to as ‘pain at rest,’ 18,22,42,48 ‘rest pain,’ 43,49 or ‘symptoms at rest.’ 35 Some studies subdivided the ‘no symptoms with exertion’ category into active and inactive participants, resulting in a total of six leg categories, 41,50 whereas Collins and colleagues 20 condensed the five symptom categories of the SDCQ into three: no pain, atypical leg pain, (pain at rest, non-calf exercise pain, and non-Rose exercise calf pain) and Rose claudication. Others followed the original five symptom categories established by the SDCQ 21 or used a general category of ‘leg symptoms’ 44 or ‘symptomatic’ that included lower extremity revascularization, amputation secondary to PAD, or report of claudication regardless of ABI.…”

Peripheral arterial occlusive disease (PAOD)

“…Proximal manifestation of arteriosclerotic stenosis or occlusion (pelvic arteries) is more common in slim and young females; we find that older men tend to have distal arterial disease (angiopathy of the lower leg) (16). Pain in the foot is characteristic of lower leg arterial disease, while pain at rest is often experienced in severe PAOD or critical limb ischaemia (see ▶ Table 3 for definitions).…”

One Year Health Status Benefits Following Treatment for New Onset or Exacerbation of Peripheral Arterial Disease Symptoms: The Importance of Patients' Baseline Health Status

“…A detailed description of the duplex ultrasound protocol has been published elsewhere. 19 Clinical risk factors. Information on clinical risk factors was abstracted from patients' medical records and included cardiac history, cerebrovascular history, current smoking, diabetes mellitus, dyslipidemia, hypertension, body mass index (BMI; kg/m 2 ), chronic obstructive pulmonary disease (COPD), renal dysfunction, back pain, and knee/hip osteoarthritis.…”