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Diagnosing vascular disease can be complex due to the variety of symptoms vascular diseases can cause. Reviewing a patient's family history and conducting a physical examination are important steps in making a diagnosis. Physical exams may differ depending on the type of vascular disease suspected.
The neurogenic type is the most common and presents with pain, weakness, paraesthesia, and occasionally loss of muscle at the base of the thumb. [1] [2] The venous type results in swelling, pain, and possibly a bluish coloration of the arm. [2] The arterial type results in pain, coldness, and pallor of the arm. [2]
The definite diagnosis of vasculitis is established after a biopsy of involved organ or tissue, such as skin, sinuses, lung, nerve, brain, and kidney. The biopsy elucidates the pattern of blood vessel inflammation. Some types of vasculitis display leukocytoclasis, which is vascular damage caused by nuclear debris from infiltrating neutrophils. [37]
The signs and symptoms of ischemia vary, as they can occur anywhere in the body and depend on the degree to which blood flow is interrupted. [4] For example, clinical manifestations of acute limb ischemia (which can be summarized as the "six P's") include pain, pallor, pulseless, paresthesia, paralysis, and poikilothermia.
Acute limb ischemia may also be caused by traumatic disruption of blood flow to a limb, which may present with either hard signs or soft signs of vascular injury. [15] Hard signs include pulsatile bleeding, expanding hematomas (collections of blood), or absent distal pulses, and must be taken to surgery emergently.
Patients may show up at the emergency room with life-threatening symptoms (such as massive hemoptysis or renal failure) or with nonspecific signs and symptoms (such as a rash, fever, myalgia, arthralgia, malaise, or weight loss) at their family physician's office. The size, location, and extent of the vessels involved all affect the manifestations.
In the setting of symptoms consistent with peripheral artery disease, a physician will then examine an individual for specific exam findings. Abnormal physical exam findings can lead a health care provider to consider a specific diagnosis. [19] However, in order to confirm a diagnosis, confirmatory testing is required. [20]
Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. [3] Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcpO2 ), or skin perfusion pressure (SPP).
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