Vascular Disorders: Arterial, Venous, Aortic and Thromboembolic Conditions
Arterial disease
Peripheral artery disease causes claudication, rest pain, hair loss, shiny skin, and weak pulses. Critical limb ischemia causes rest pain, ulcers, or gangrene. The ankle-brachial index is the key test; values below 0.90 suggest PAD, and below 0.40 suggest severe disease. Falsely elevated ABIs occur with calcified vessels. Acute arterial occlusion is a surgical emergency: pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia.
Venous and thromboembolic disease
DVT presents with unilateral swelling, warmth, and tenderness; PE causes dyspnea, tachycardia, chest pain, and hypoxemia. Anticoagulation is the mainstay, with compression and early mobilization. Venous ulcers are typically medial, shallow, and associated with edema; arterial ulcers are punched out and painful.
Aortic disease
Aortic dissection causes sudden tearing pain, pulse deficits, and blood pressure differential; immediate blood pressure and heart rate control are priorities. Aortic aneurysm may be asymptomatic until rupture. Postoperative monitoring includes pulses, perfusion, urine output, and spinal cord ischemia.
Traps
Do not massage a suspect DVT. Do not apply compression before ruling out arterial insufficiency. Normal pulses do not exclude dissection.
Rule of thumb
Arterial problems are pale and pulseless; venous problems are swollen and warm. Escalate acute limb ischemia immediately.