Peripheral Arterial Occlusive Disease

Aka: Peripheral Arterial Occlusive Disease, Peripheral Arterial Disease, Peripheral Artery Disease, Peripheral Vascular Disease, Arterial Insufficiency, Claudication, Vascular Claudication, Aortoilliac Occlusive Disease, Leriche's Syndrome, Iliac Artery Stenosis, Iliofemoral Occlusive Disease, Femoropopliteal Occlusive Disease, Femoropopliteal Stenosis, Femoral Arterial Stenosis, Intermittent Claudication, Arterial Atherosclerosis, Arteriosclerosis, Arterial Occlusive Disease

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II. Background

  1. Claudication derived from latin claudicatio, to limp

III. Epidemiology: Prevalence

  1. Overall
    1. 7-12 million affected in United States
    2. 200 million affected worldwide
  2. Age
    1. Age over 60 years: 3 to 6%
    2. Age over 70 years: 10 to 18%
    3. Age over 85 years: 50%
  3. References
    1. Benjamin (2018) Circulation 137(12): e67-492 [PubMed]

IV. Risk Factors

  1. Precautions
    1. Risks are additive (1.5 fold increase for 1 risk factor, 10 fold increase with 3 or more risk factors)
  2. Age over 60 (Odds Ratio 4.1)
  3. Cerebrovascular Disease (Odds Ratio 3.6)
  4. Coronary Artery Disease (Odds Ratio 3.5)
  5. Diabetes Mellitus (Odds Ratio 2.5)
  6. Hyperlipidemia (Odds Ratio 1.9)
  7. Tobacco Abuse (risk persists >5 years after cessation)
    1. Cigarette smoking 20 per day: 2.11 Relative Risk
    2. Cigarette smoking 11-20 per day: 1.75 Relative Risk
    3. In one study, 80% of PAD cases were in current or former smokers
    4. Meijer (1998) Arterioscler Thromb Vasc Biol 18(20: 185-92 [PubMed]
  8. Black race
  9. Systolic Hypertension
  10. Hyperhomocysteinemia
  11. Increased Body Mass Index (Obesity)
  12. C-Reactive Protein increased
  13. Chronic Kidney Disease with GFR rate <60 ml/min/1.73m2
  14. Eraso (2014) Eur J Prev Cardiol 21(6): 704-11 [PubMed]

V. Associated Conditions

  1. Coronary Artery Disease (Myocardial Infarction)
    1. Major adverse cardiac events (MI, CVA, CV-related death)
  2. Carotid Stenosis (Cerebrovascular Accident)
  3. Abdominal Aortic Aneurysm (9% comorbid Prevalence, 15.8% if age >75 years)
    1. Giugliano (2012) BMC Surg 12(Suppl 1): S17 [PubMed]

VI. Symptoms

  1. Presentations
    1. Classic Claudication: 10% of cases
    2. Atypical Leg Pain: 50% of cases
    3. Asymptomatic: 40% of cases
  2. Classic Claudication
    1. Cramp-like leg Muscle pain or Fatigue with Exercise, better with rest
      1. Calf pain typical (pain may occur in thigh, buttock)
    2. Pain worse with exertion
    3. Pain relieved within 10 minutes rest
    4. Pain relieved with rest and dependent position
  3. Critical Limb Ischemia (1% of presentations)
    1. Tissue loss or gangrene
    2. Burning pain or numbness in the forefoot may awaken patient
    3. Pain improves with hanging leg over the side of the bed (with dependent redness or rubor)
    4. Chronic (>2 weeks) ischemic rest pain, often occurring soon after falling asleep
      1. Chronicity allows for collateral vessel development and preserved limb viability despite severe symptoms
  4. Acute Limb Ischemia (see management below)
    1. Cold, painful, pale limb with diminished or absent pulses
    2. Motor weakness
    3. Decreased Sensation
    4. Abrupt onset allows for no collateral circulation, and a short window of viable tissue for revascularization
  5. Timing of symptoms related to degree of stenosis
    1. Exertional pain: 70% arterial pain
    2. Nocturnal pain: 70 to 90% arterial stenosis
    3. Ischemic rest pain: 90% arterial stenosis

VII. Exam

  1. Vascular Exam (Arterial Bruits or diminished pulses)
    1. Abdominal aorta bruit
    2. Femoral artery bruit
    3. Femoral artery pulse
    4. Dorsalis pedis pulse (absent in up to 3% of normal patients)
    5. Posterior tibial pulse
    6. Carotid Artery pulse and bruit (for comorbid Carotid Stenosis)
  2. Neurologic Exam
    1. Critical in determining Acute Limb Ischemia degree (see Rutherford Classification below)
    2. Extremity Motor Exam
    3. Extremity Sensory Exam

VIII. Signs

  1. Most reliable signs of Peripheral Vascular Disease (Sensitivity, Specificity assumes ABI<0.9)
    1. Posterior tibial artery Doppler Ultrasound
      1. All 3 components present rules-out Peripheral Arterial Disease
      2. Only 1 of 3 components present is strongly suggestive of PAD (Positive Likelihood Ratio = 7.0)
    2. Dorsalis pedis AND posterior tibial pulse absent
      1. Test Sensitivity: 63%
      2. Test Specificity: 99%
    3. Femoral artery bruit
      1. Test Sensitivity: 29%
      2. Test Specificity: 95%
    4. Atypical Skin Color (pale, red, blue) of extremity
      1. Test Sensitivity: 35%
      2. Test Specificity: 87%
  2. Local Signs of Peripheral Vascular Disease
    1. Dry, scaly, shiny atrophic skin
    2. Skin hairless over lower extremity (e.g. shin)
    3. Dystrophic, brittle Toenails
    4. Non-healing ulcers or other lower extremity wounds
      1. See Arterial Ulcer
      2. Ulcers are well-demarcated and appear to be "punched out"
    5. Decreased skin Temperature (cool feet)
    6. Decreased Capillary Refill Time
    7. Distal extremity color change with position
      1. Skin rubor when leg dependent
      2. Skin pallor when leg elevated >1 minute
        1. Color returns within 15 seconds in mild cases
        2. Delay >40 seconds suggests severe ischemia

IX. Signs: Acute Limb Ischemia (5 P's)

  1. Early finding
    1. Pain
  2. Late findings
    1. Pulselessness
    2. Pallor
    3. Paresthesias
    4. Paralysis

X. Signs: Occlusion Location

  1. Inflow Disease: Aortoilliac Occlusive Disease
    1. Also known as Leriche's Syndrome
    2. Bilateral leg diminished pulses throughout
    3. Slow Wound Healing legs
    4. Impotence
  2. Outflow Disease
    1. Iliofemoral Occlusive Disease
      1. Unilateral leg diminished pulses throughout
      2. Buttock Claudication may be present
    2. Femoropopliteal Occlusive Disease
      1. Thigh and calf Claudication
      2. Normal femoral pulses in groin

XI. Classification

  1. Rutherford Classification of Acute Limb Ischemia
    1. Category I: Viable (no immediate threat)
      1. No sensory deficit
      2. No motor deficit
      3. Arterial doppler audible but typically monophasic (but venous doppler audible)
    2. Category IIA: Marginally threatened (salvageable if promptly treated)
      1. Minimal sensory deficit (e.g. toes involved)
      2. No motor deficit
      3. Arterial doppler inaudible (but venous doppler audible)
    3. Category IIB: Immediately Threatened (salvageable if immediately revascularized)
      1. Sensory deficit with rest pain
      2. Mild to moderate motor deficit
      3. Arterial doppler inaudible (but venous doppler audible)
    4. Category III: Irreversible (major tissue loss with permanent nerve injury)
      1. Severe sensory deficit with complete Anesthesia
      2. Severe motor deficit with paralysis or rigor
      3. Arterial doppler inaudible (but venous doppler audible)
  2. Fontaine Stage
    1. Stage I: Asymptomatic
      1. Ankle-Brachial Index < 0.9
      2. Decreased distal pulses
    2. Stage II: Intermittent Claudication
    3. Stage III: Daily rest pain
    4. Stage IV: Focal tissue necrosis (non-healing ulcers)
      1. Ankle-Brachial Index < 0.3 (50% block)
  3. Grading Claudication
    1. Initial Claudication Distance
      1. Distance patient first experiences exertional pain
    2. Absolute Claudication Distance
      1. Furthest distance patient is able to walk

XII. Differential Diagnosis

  1. See Leg Pain
  2. See Hip Pain
  3. See Knee Pain
  4. See Foot Pain
  5. Common and important other Leg Pain causes
    1. Lumbar Spinal Stenosis (Pseudoclaudication)
    2. Peripheral Neuropathy (e.g. Diabetic Neuropathy)
    3. Nerve Entrapment (e.g. Meralgia Paresthetica, Posterior Tarsal Tunnel Syndrome)
    4. Night Cramps
    5. Exertional Compartment Syndrome (or Chronic Compartment Syndrome)
    6. Stress Fracture
    7. Arthritis
    8. Intermittent Claudication (Peripheral Vascular Disease)
    9. Deep Vein Thrombosis (DVT)
    10. Venous Insufficiency
  6. Acute Limb Ischemia differential diagnosis
    1. Congestive Heart Failure with superimposed PVD
      1. Identical presentation to limb ischemia
    2. Deep Venous Thrombosis
      1. Blue extremity without pallor
      2. Swollen, painful extremity
    3. Acute Spinal Cord Compression
      1. Skin Color normal
      2. Limb paralysis with pain and Paresthesias
  7. Acute Limb Ischemia sites of compromise proximal to extremity
    1. Thoracic Aortic Dissection
    2. Abdominal Aortic Aneurysm (AAA)
    3. Embolic phenomenon from a cardiac source

XIII. Labs

  1. Complete Blood Count with Platelets
  2. Lipid profile
  3. Serum Homocysteine
  4. Apolipoprotein A
  5. Serum Creatinine
  6. Hemoglobin A1C or Fasting Serum Glucose
  7. Urinalysis for glucosuria or Proteinuria
  8. Consider screening for Hypercoagulability

XIV. Diagnosis

  1. See Edinburgh Claudication Questionnaire
  2. See PAD Score
  3. See Segmental Arterial Pressure
  4. Ankle-Brachial Index
    1. ABI is the Vital Sign of Peripheral Arterial Disease
    2. Obtain for diagnosis and monitor periodically for disease progression
    3. Ankle-Brachial Ratio >1.4: Non-compressable vessels (False Negative)
    4. Ankle-Brachial Ratio >0.9: Normal
    5. Ankle-Brachial Ratio <0.5: Severe, multi-level disease
    6. Ankle-Brachial Ratio <0.3: Limb Threatening Ischemia (requires emergent intervention)
    7. Ankle-Brachial Ratio <0.2: Gangrenous extremity
  5. Alternative Studies
    1. Toe-Brachial Ratio
      1. Typically 0.7 to 0.8
      2. Abnormal <0.7 (severe if <0.4)
    2. Exercise ABI Testing
      1. Obtain ABI immediately after walking 5 minutes on treadmill at 12% grade and 2.0 miles/h OR
      2. Symptoms require patient to stop
    3. Six-Minute Walk Test

XV. Imaging

  1. Ultrasound
    1. Ultrasound Ankle-Brachial Index
    2. Segmental Arterial Doppler Ultrasound
    3. Abdominal Aorta Ultrasound
      1. Consider at time of periperal arterial disease diagnosis (due to association with AAA)
  2. CT Angiography
    1. CTA Abdomen and Pelvis with limb runoff
    2. Preferred definitive study in Acute Limb Ischemia

XVI. Screening: Indications with Ankle-Brachial Index

  1. Guidelines vary per organization
    1. USPTF does not recommend routine screening unless symptomatic
      1. Symptom Example: Exertional Leg Pain or non-healing distal extremity wounds
    2. Cardiovascular Risk Reduction even without PAD diagnosis will benefit PAD in addition to other vascular disease
  2. Diabetes Mellitus (ADA, ACC/AHA)
    1. Start at age 50 years or earlier if other comorbid PAD Risk Factors
      1. Other example risks: Tobacco Abuse, Hyperlipidemia, Diabetes Mellitus >10 years
    2. Repeat every 5 years
  3. Age over 65 years old (ACC/AHA)
  4. Age 50 to 64 years old AND atherosclerosis risks (Hypertension, Diabetes Mellitus, Hyperlipidemia, Tobacco, FHx PAD)
  5. Known vascular disease affecting another system (e.g. AAA, Carotid Stenosis, Coronary Artery Disease, Mesenteric Ischemia)

XVII. Grading

  1. History
    1. Degree of extremity pain
    2. Pain-free walking distance
  2. Questionaires (e.g. Walking Impairment Questionaire)
  3. Treadmill testing
    1. Maximal walking distance
    2. Pain-free walking distance

XVIII. Course

  1. Typical course of non-critical ischemia
    1. Claudication remains stable in 80% of patients
    2. Five year risk of Claudication worsening: 16%
    3. Claudication requiring surgery: 25%
  2. Risk of limb loss (amputation)
    1. Stable non-critical ischemia
      1. Risk at five years: 4-7%
      2. Risk at ten years: 12%
    2. Critical Limb Ischemia
      1. Risk at 6-12 months from onset: 80-90%
  3. Five year Mortality from atherosclerotic cause: 29%
    1. Coronary Artery Disease deaths: 60%
    2. Cerebrovascular Accident related deaths: 15%
  4. Overall survival
    1. Survival at ten years: 38%
    2. Survival at fifteen years: 22%

XIX. Management

  1. Acute Limb Ischemia (Emergency management)
    1. See Acute Limb Ischemia
  2. Chronic Claudication
    1. See Peripheral Vascular Disease Management (Claudication Management)
    2. Cardiovascular Risk Reduction is critical
      1. PAD carries same risk as Coronary Artery Disease

XX. Prognosis

  1. See Peripheral Arterial Disease 10-Year Mortality Index
  2. Intermittent Claudication progresses to Critical Limb Ischemia in 21% of cases
  3. Critical Limb Ischemia is associated with a 25% annual mortality rate (esp. due to cardiovascular cause)

XXI. Resources

  1. Vascular Disease Foundation
    1. http://www.vdf.org

XXII. References

  1. Boccalon (1999) Drugs Aging 14:247
  2. Broder (2024) Crit Dec Emerg Med 38(4): 23-4
  3. Boyd (1962) Proc R Soc Med 55:591-96 [PubMed]
  4. Carman (2000) Am Fam Physician 61(4):1027-32 [PubMed]
  5. Firnhaber (2019) Am Fam Physician 99(6): 362-9 [PubMed]
  6. Firnhaber (2022) Am Fam Physician 105(1): 65-72 [PubMed]
  7. Gardner (1995) JAMA 274(12):975-80 [PubMed]
  8. Gey (2004) Am Fam Physician 69:525-33 [PubMed]
  9. Hennion (2013) Am Fam Physician 88(5): 306-10 [PubMed]
  10. Hirsch (2001) JAMA 286(11):1317-24 [PubMed]
  11. Imparato (1975) Surgery 78:795-9 [PubMed]
  12. Samuelson (March, 2000) Fed Pract, p. 34-50
  13. Santilli (1999) Am Fam Physician 59(7):1899-908 [PubMed]
  14. Santilli (1996) Am Fam Physician 53(4):1245-53 [PubMed]
  15. Sontheimer (2006) Am Fam Physician 73(11):1971-6 [PubMed]
  16. (1999) Med Lett Drugs Ther 41:(1052):44-6 [PubMed]

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Related Studies

Ontology: Arterial insufficiency (C0003834)

Concepts Disease or Syndrome (T047)
SnomedCT 195374003
Italian Insufficienza arteriosa
Japanese 動脈不全, ﾄﾞｳﾐｬｸﾌｾﾞﾝ
English arterial insufficiency, arterial insufficiency (diagnosis), arterial insufficiencies, Arterial insufficiency, Arterial insufficiency (disorder), insufficiency; arterial, artery; insufficiency
Czech Arteriální nedostatečnost
Hungarian Arteriás elégtelenség
Dutch arterie; insufficiëntie, insufficiëntie; arteria, arteriële insufficiëntie
Spanish insuficiencia arterial (trastorno), insuficiencia arterial, Insuficiencia arterial
Portuguese Insuficiência arterial
French Insuffisance artérielle
German arterielle Insuffizienz
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Arterial Occlusive Diseases (C0003838)

Definition (MSH) Pathological processes which result in the partial or complete obstruction of ARTERIES. They are characterized by greatly reduced or absence of blood flow through these vessels. They are also known as arterial insufficiency.
Concepts Disease or Syndrome (T047)
MSH D001157
SnomedCT 2929001
English Arterial Obstructive Disease, Arterial Obstructive Diseases, Arterial Occlusive Disease, Arterial Occlusive Diseases, Disease, Arterial Obstructive, Disease, Arterial Occlusive, Diseases, Arterial Obstructive, Diseases, Arterial Occlusive, Obstructive Disease, Arterial, Obstructive Diseases, Arterial, Occlusive Disease, Arterial, Occlusive Diseases, Arterial, ARTERIAL OBSTRUCTIVE DIS, ARTERIAL OCCLUSIVE DIS, Arterial Occlusive Diseases [Disease/Finding], arterial disease occlusive, arterial occlusive disease, obstructive arterial disease, arterial obstructive disease, arterial occlusive diseases, occlusive arterial disease, Arterial occlusive disease
Italian Malattia arteriosa occlusiva, Patologie ostruttive dell'aorta, Patologie occlusive dell'aorta
Swedish Pulsåderförträngning
Japanese ﾄﾞｳﾐｬｸﾍｲｿｸｾｲｼｯｶﾝ, 動脈閉塞, 動脈閉塞性疾患, 動脈閉塞疾患, 動脈閉塞症
Czech arteriální stenóza, arteriální okluzní nemoci, artérie - uzávěr, Arteriální okluzivní nemoc
Finnish Valtimoita tukkivat sairaudet
Russian ARTERII OKKLIUZIRUIUSHCHIE BOLEZNI, ARTERIAL'NAIA OBSTRUKTIVNAIA BOLEZN', АРТЕРИАЛЬНАЯ ОБСТРУКТИВНАЯ БОЛЕЗНЬ, АРТЕРИЙ ОККЛЮЗИРУЮЩИЕ БОЛЕЗНИ
Croatian ARTERIJSKE OKLUZIVNE BOLESTI
Polish Choroby tętnic zarostowe, Choroby tętnic zwężające
Hungarian Arteriák occlusiv betegsége
Norwegian Arteriell okklusjon, Åretilstopping, Tilstopping av årene
Spanish enfermedad oclusiva arterial, Enfermedad arterial oclusiva, Arteriopatías Obstructivas, Arteriopatías Oclusivas
Portuguese Doença oclusiva arterial, Arteriopatias Obstrutivas, Arteriopatias Oclusivas
Dutch arteriële occlusieve ziekte, Arteriëleobstructieziekte, Arteriële occlusiestoornis, Occlusiestoornis, arteriële
French Maladie occlusive artérielle, Artériopathies oblitérantes, Maladies artérielles occlusives
German arterielle Verschlusskrankheit, Arterielle obturierende Krankheiten, Arterielle Verschlußkrankheiten
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Arteriosclerosis (C0003850)

Definition (NCI) A vascular disorder characterized by thickening and hardening of the walls of the arteries.
Definition (CSP) thickening and loss of elasticity of arterial walls; atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries; additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis).
Definition (MSH) Thickening and loss of elasticity of the walls of ARTERIES of all sizes. There are many forms classified by the types of lesions and arteries involved, such as ATHEROSCLEROSIS with fatty lesions in the ARTERIAL INTIMA of medium and large muscular arteries.
Concepts Disease or Syndrome (T047)
MSH D001161 , D050197
ICD10 I70
SnomedCT 155418003, 195257001, 266318005, 155414001, 195251000, 72092001, 28960008, 107671003
English Arterioscleroses, Arteriosclerotic vasc.dis.NOS, Vascular Sclerosis, Arterial Sclerosis, arteriosclerotic vascular disease, Arteriosclerosis [Disease/Finding], arteriosclerosis, arterioscleroses, Arteriosclerosis, Arteriosclerotic vascular disease NOS (disorder), Arteriosclerosis NOS, Atherosclerosis, arteriosclerotic vascular disease (diagnosis), ARTERIOSCLEROSIS, Arteriosclerosis (morphologic abnormality), Arteriosclerotic vascular disease (disorder), Arteriosclerotic vascular disease, Vascular sclerosis (morphologic abnormality), Vascular sclerosis, Arteriosclerotic vascular disease, NOS, Arteriosclerosis, NOS, Arteriosclerotic vascular disease NOS
French ARTERIOSCLEROSE, Artériosclérose, Athérosclérose
Portuguese ARTERIOSCLEROSE, Arteriosclerose, Aterosclerose
Spanish ARTERIOSCLEROSIS, arteriosclerosis (anomalía morfológica), arteriosclerosis, arterioesclerosis (anomalía morfológica), arterioesclerosis, arterioesclerosis (trastorno), vasculopatía arteriosclerótica, vasculopatía arteriosclerótica (trastorno), enfermedad vascular arteriosclerótica, SAI, enfermedad vascular arteriosclerótica, SAI (trastorno), Arteriosclerotic vascular disease NOS, Arterioesclerosis, esclerosis vascular (anomalía morfológica), esclerosis vascular, Arteriosclerosis
German ARTERIOSKLEROSE, Arteriosklerose, Atherosklerose
Japanese 動脈硬化症, ﾄﾞｳﾐｬｸｺｳｶｼｮｳ, 粥状硬化症, アテローム性動脈硬化, 粥状硬化, じゅく状硬化症, アテローム硬化症, 動脈硬化症-粥状, アテローム性動脈硬化症, アテローム動脈硬化, 粥状動脈硬化症, 動脈脂肪斑, アテローム動脈硬化症, 粥状動脈硬化, 動脈硬化症-アテローム性, アテローム硬化
Swedish Arterioskleros
Czech ateroskleróza, arterioskleróza, Arterioskleróza, ucpávání tepen
Finnish Valtimonkovettumistauti, Ateroskleroosi
Russian ATEROGENEZ, ATEROSKLEROZ, ARTERIOSKLEROZ, ZHIROVAIA PROZHILKA ARTERIAL'NAIA, АРТЕРИОСКЛЕРОЗ, ЖИРОВАЯ ПРОЖИЛКА АРТЕРИАЛЬНАЯ, АТЕРОГЕНЕЗ
Croatian ATEROSKLEROZA, ARTERIOSKLEROZA
Polish Lipidowe stłuszczenie tętnic, Ognisko kaszakowate, Miażdżyca tętnic, Arterioskleroza, Stwardnienie tętnic, Stwardnienie tętnic miażdżycowe
Hungarian Arteriosclerosis
Norwegian Åreforkalkning, Arteriosklerose, Aterosklerose
Dutch arteriosclerose, Arteriosclerose
Italian Arteriosclerosi, Aterosclerosi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Intermittent Claudication (C0021775)

Definition (MSH) A symptom complex characterized by pain and weakness in SKELETAL MUSCLE group associated with exercise, such as leg pain and weakness brought on by walking. Such muscle limpness disappears after a brief rest and is often relates to arterial STENOSIS; muscle ISCHEMIA; and accumulation of LACTATE.
Concepts Disease or Syndrome (T047)
MSH D007383
ICD10 I73.9
SnomedCT 195312007, 155430009, 63491006
French CLAUDICATION INTERMITTENTE, Myasthénie angiosclérotique, Maladie de Charcot, Claudication intermittente
English CLAUDICATION INTERMITTENT, Claudication, Intermittent, Intermittent Claudication, intermittent claudication, intermittent claudication (diagnosis), Claudication intermittent, Intermittent Claudication [Disease/Finding], Claudication;intermittent, claudication intermittent, charcot's syndrome, intermittent claudications, Claudication (& [intermittent]), Claudication (& [intermittent]) (disorder), Angiosclerotic myasthenia, Charcot's syndrome, Intermittent claudication, Myasthenia angiosclerotica, IC - Intermittent claudication, Intermittent claudication (disorder), claudication, intermittent, Charcot; syndrome, syndrome; Charcot, Intermittent claudication NOS
Portuguese CLAUDICACAO INTERMITENTE, Síndrome de Charcot, Miastenia angiosclerótica, Claudicação intermitente, Claudicação Intermitente
Spanish CLAUDICACION INTERMITENTE, Síndrome de Charcot, Miastenia angiosclerótica, claudicación intermitente (trastorno), claudicación intermitente, miastenia angioesclerótica, síndrome de Charcot, Claudicación intermitente, Claudicación Intermitente
German CLAUDICATIO INTERMITTENS, angiosklerotische Myasthenie, Charcot-Syndrom, Claudicatio intermittens
Dutch angiosclerotische myasthenie, claudicatio intermittens, syndroom van Charcot, Charcot; syndroom, syndroom; Charcot, intermitterende claudicatio, Claudicatio intermittens
Italian Sindrome di Charcot, Miastenia angiosclerotica, Claudicazione intermittente
Japanese 動脈硬化性筋無力症, 間欠性跛行, シャルコー症候群, ﾄﾞｳﾐｬｸｺｳｶｾｲｷﾝﾑﾘｮｸｼｮｳ, ｶﾝｹﾂｾｲﾊｺｳ, ｼｬﾙｺｰｼｮｳｺｳｸﾞﾝ
Swedish Fönstertittarsjuka
Czech intermitentní klaudikace, Intermitentní klaudikace, Angiosklerotická myastenie, Charcotův syndrom, klaudikace intermitentní
Finnish Katkokävely
Russian PEREMEZHAIUSHCHAIASIA KHROMOTA, KHROMOTA PEREMEZHAIUSHCHAIASIA, ПЕРЕМЕЖАЮЩАЯСЯ ХРОМОТА, ХРОМОТА ПЕРЕМЕЖАЮЩАЯСЯ
Polish Chromanie przestankowe
Hungarian Angiosclerotikus myasthenia, Charcot-syndroma, Claudicatio intermittens
Norwegian Røykeben, Claudicatio intermittens, Nedsatt blodsirkulasjon i beina, Vindustittersykdom, Røykebein, Åreforkalkning i beina, Åreforkalkning i beinene, Åreforkalkning i benene
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Leriche Syndrome (C0023370)

Definition (NCI) An atherosclerotic disorder of the peripheral vascular system affecting mostly males in their later decades. It is caused by thrombotic occlusion of the abdominal aorta just above the level of the bifurcation. Clinical signs include impotence, intermittent claudication, diminished femoral pulses and cold, pallid lower extremities. Prognosis is favorable with surgical or endovascular intervention.
Definition (MSH) A condition caused by occlusion of terminal aorta, the primary branches of the ABDOMINAL AORTA, as in aortoiliac obstruction. Leriche syndrome usually occurs in males and is characterized by IMPOTENCE, absence of a pulse in the femoral arteries, weakness and numbness in the lower back, buttocks, hips, and lower limbs.
Concepts Disease or Syndrome (T047)
MSH D007925
ICD9 444.01
ICD10 I74.09 , I74.01
SnomedCT 307816004, 56336009, 195316005, 233972005, 37778000
English Leriches Syndrome, Syndrome, Leriche's, AORTIC OCCLUSION DISTAL CHRONIC, Syndrome, Leriche, Leriche's Syndrome, saddle embolus of abdominal aorta (diagnosis), saddle embolus of abdominal aorta, Leriche syndrome (diagnosis), Saddle embolus of aorta, Leriche syndrome, Leriche Syndrome [Disease/Finding], leriches syndrome, leriche syndrome, syndrome leriche, leriche's syndrome, Saddle embolus abd aorta, Leriche Syndrome, Aortic bifurcation syndrome (disorder), Leriche's syndrome, Aortic bifurcation syndrome, Aortoiliac obstruction, Saddle embolus of abdominal aorta, Aortic bifurcation embolus, Saddle embolus, Leriche's syndrome (disorder), Aortic bifurcation embolus (disorder), Saddle embolus (morphologic abnormality), bifurcation; aortic, syndrome, Leriche, embolism; aortic, bifurcation, embolism; aortic, saddle, saddle embolus; aorta, syndrome; aortic bifurcation, thrombosis; aortic, bifurcation, aorta; bifurcation, syndrome, aorta; embolism, bifurcation, aorta; embolism, saddle, aorta; saddle embolus, aorta; thrombosis, bifurcation, aortic bifurcation; syndrome, Aortic bifurcation syndrome (disorder) [Ambiguous]
Dutch ruiterembolie van de aorta, aorta; bifurcatie, syndroom, aorta; embolie, bifurcatie, aorta; embolie, ruiter, aorta; trombose, bifurcatie, aorta; zadel-embolus, aortabifurcatie; syndroom, bifurcatie; aorta, syndroom, embolie; aorta, bifurcatie, embolie; aorta, ruiter, syndroom; aortabifurcatie, trombose; aorta, bifurcatie, zadel-embolus; aorta, Leriche-syndroom, Syndroom, Leriche-
French Embole aortique en selle, Syndrome de Leriche
German reitender Aortenembolus, Leriche Syndrom, Aortenbifurkationssyndrom, Leriche-Syndrom
Italian Embolo aortico a sella, Sindrome di Leriche
Portuguese Êmbolo em sela da aorta, Síndrome de Lériche, Síndrome de Leriche
Spanish Émbolo cabalgante de aorta, émbolo de aorta abdominal en silla de montar, síndrome de la bifurcación aórtica, obstrucción aortoilíaca (trastorno), obstrucción aortoilíaca, síndrome de Leriche (concepto no activo), síndrome de Leriche (trastorno), síndrome de Leriche, síndrome de bifurcación aórtica, émbolo en silla de montar (anomalía morfológica), émbolo en silla de montar de la aorta abdominal, émbolo en silla de montar, Síndrome de Leriche
Japanese 大動脈鞍状塞栓, ﾙﾘｰｼｭｼｮｳｺｳｸﾞﾝ, ﾀﾞｲﾄﾞｳﾐｬｸｱﾝｼﾞｮｳｿｸｾﾝ, Leriche症候群, ルリッシュ症候群, ルリーシュ症候群, レリシュ症候群, 血栓性大動脈分岐部閉塞症
Swedish Leriches syndrom
Czech Lericheův syndrom, Lerichův syndrom, Sedlovitý embolus v aortě
Finnish Lerichen oireyhtymä
Russian LERISHA SINDROM, ЛЕРИША СИНДРОМ
Croatian LERICHEOV SINDROM
Polish Zespół Leriche'a, Niedrożność aortalno-biodrowa
Hungarian Leriche-syndroma, Aorta lovagló embolusa
Norwegian Leriche-syndrom, Leriches syndrom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Peripheral Vascular Diseases (C0085096)

Definition (MSHCZE) Patologické procesy cév na mimosrdeční vaskulatuře.
Definition (NCI) Any disorder affecting blood flow through the veins or arteries outside of the heart.
Definition (CSP) condition in which there is a deviation from or interruption of the normal structure or function of the blood vessels outside the heart; diseases of the peripheral as opposed to the cardiac circulation.
Definition (MSH) Pathological processes involving any one of the BLOOD VESSELS in the vasculature outside the HEART.
Concepts Disease or Syndrome (T047)
MSH D016491
ICD9 443.9
ICD10 I73.9
SnomedCT 266320008, 195311000, 91523003, 155431008, 266321007, 195314008, 155433006, 400047006, 399957001
LNC MTHU020791
English Angiopathies, Peripheral, Disease, Peripheral Vascular, Diseases, Peripheral Vascular, Peripheral Angiopathies, Peripheral Angiopathy, Vascular Disease, Peripheral, Vascular Diseases, Peripheral, peripheral blood vessel disorder, Angiopathy, Peripheral, PVD - Periph vascular disease, Peripheral vasc.disease NOS, Peripheral vascular disease NOS, Peripheral vascular disease, unspecified, PERIPHERAL VASCULAR DISORDER NOS, PERIPHERAL VASCULAR DIS, VASCULAR DIS PERIPHERAL, DIS PERIPHERAL VASCULAR, peripheral vascular disease (diagnosis), PVD (peripheral vascular disease), peripheral vascular disease, Circulatory disorder peripheral, Disorder peripheral vascular, Disorder vascular peripheral, Peripheral vascular disorder NOS, Vascular disorder peripheral, Peripheral Vascular Disease, Periph vascular dis NOS, Peripheral vascular disease unspecified, Peripheral angiopathy NOS, Peripheral Vascular Diseases [Disease/Finding], peripheral arterial disease, arterial diseases peripheral, peripheral vascular disorder, Disease;peripheral vascular, circulatory disorders peripheral, pvds, circulatory disorder peripheral, pvd, peripheral angiopathy, peripheral vascular disease (PVD), peripheral vascular diseases, Peripheral Vascular Diseases, Vasc. dis. periph. NOS, Peripheral vascular disease NOS (disorder), Peripheral vascular dis. NOS, Peripheral vasc. disease NOS, Peripheral vascular disease (& [NOS]) (disorder), Peripheral vascular disease (& [NOS]), Peripheral vascular diseases, PERIPHERAL VASCULAR DISEASE, VASCULAR DISEASE, PERIPHERAL, DISEASE, PERIPHERAL VASCULAR, Peripheral vascular disorder, Peripheral vascular disease, PVD - Peripheral vascular disease, Peripheral angiopathy, Peripheral vascular disease (disorder), PVD-peripheral vascular disease, disease (or disorder); peripheral, vascular, peripheral; angiopathy, angiopathy; peripheral, Peripheral angiopathy, NOS, Peripheral vascular disease, NOS, Peripheral Vascular Disorder, peripheral angiopathies
French MALADIE VASCULAIRE PERIPHERIQUE, Trouble de la circulation périphérique, Affection des vaisseaux périphériques, Maladie vasculaire périphérique SAI, Maladie vasculaire périphérique, non précisée, Trouble des vaisseaux périphériques, Trouble vasculaire périphérique SAI, Maladie vasculaire périphérique, AFFECTIONS VASCULAIRES PERIPH, Trouble vasculaire périphérique, Angiopathies périphériques, Maladies vasculaires périphériques, Vasculopathies périphériques
Italian Disturbo vascolare periferico, Disturbo vascolare periferico NAS, Patologia vascolare periferica, Malattia vascolare periferica NAS, Disturbo circolatorio periferico, Malattia vascolare periferica, Malattia vascolare periferica non specificata, Angiopatie periferiche, Malattie dei vasi periferici
Dutch perifere circulatoire aandoening, perifere vasculaire ziekte NAO, niet-gespecificeerde perifere vasculaire ziekte, perifere vasculaire aandoening NAO, perifere vasculaire ziekte, aandoening perifeer vasculair, aandoening vasculair perifeer, vasculaire aandoening perifeer, aandoening; perifeer, vasculair, angiopathie; perifeer, perifeer; angiopathie, Perifere vaatziekte, niet gespecificeerd, perifere vasculaire aandoening, Perifere angiopathie, Perifere vaatziekte, Perifere vaatziekten, Vaatziekten, perifere, Ziekte, perifere vaat-, Ziekten, vaat-, perifere
German Kreislauferkrankung peripher, periphere Gefaesserkrankung NNB, Periphere Gefaesserkrankungen NNB, periphere Gefaesserkrankung, unspezifisch, Gefaesserkrankung peripher, GEFAESSERKRANKUNG PERIPHER, PERIPHERE GEFAESSVERAENDERUNGEN N, Periphere Gefaesskrankheit, nicht naeher bezeichnet, periphere Gefaesserkrankung, Periphere Angiopathien, Periphere Gefäßkrankheiten, Vaskuläre Krankheiten, periphere
Portuguese Afecção vascular periferal NE, Vasculopatia periférica NE, Afecção vascular periférica, Afecção circulatória periférica, Vasculopatia periférica, DOENCA VASCULAR PERIFERICA NE, DOENCA VASCULAR PERIFERICA, Doenças Arteriais Periféricas, Anomalia vascular periférica, Angiopatias Periféricas, Doenças Vasculares Periféricas
Spanish Enfermedad vascular periférica NEOM, Enfermedad vascular periférica no especificada, Enfermedad vascular periférica, Trastorno vascular periférico NEOM, Trastorno circulatorio periférico, VASCULAR PERIFERICA, ENFERMEDAD, Peripheral vascular disease NOS, vasculopatía periférica (trastorno), vasculopatía periférica, SAI, vasculopatía periférica, angiopatía periférica, enfermedad vascular periférica, SAI, vasculopatía periférica, SAI (trastorno), Enfermedades Arteriales Periféricas, enfermedad vascular periférica (trastorno), enfermedad vascular periférica, Trastorno vascular periférico, Angiopatías Periféricas, Enfermedades Vasculares Periféricas
Japanese 末梢血管疾患、詳細不明, 末梢血管障害ＮＯＳ, 末梢血管疾患ＮＯＳ, 末梢血管障害, ﾏｯｼｮｳｹｯｶﾝｼｯｶﾝNOS, ﾏｯｼｮｳｹｯｶﾝｼｮｳｶﾞｲ, ﾏｯｼｮｳｹｯｶﾝｼｯｶﾝ, ﾏｯｼｮｳｹｯｶﾝｼｯｶﾝｼｮｳｻｲﾌﾒｲ, ﾏｯｼｮｳｼﾞｭﾝｶﾝｼｮｳｶﾞｲ, ﾏｯｼｮｳｹｯｶﾝｼｮｳｶﾞｲNOS, 末梢血管疾患, 血管疾患-末梢, 末梢血管症, 循環障害-末梢, 末梢循環障害
Swedish Perifera kärlsjukdomar
Czech periferní angiopatie, Porucha periferního oběhu, Periferní cévní choroba, blíže neurčená, Periferní cévní porucha, Periferní cévní choroba NOS, Periferní cévní porucha NOS, Periferní cévní choroba, cévy periferní - nemoci, onemocnění periferních cév
Finnish Ääreisverisuonten taudit
Russian KROVENOSNYKH SOSUDOV PERIFERICHESKIKH BOLEZNI, ANGIOPATIIA PERIFERICHESKAIA, SOSUDISTYE BOLEZNI PERIFERICHESKIE, АНГИОПАТИЯ ПЕРИФЕРИЧЕСКАЯ, КРОВЕНОСНЫХ СОСУДОВ ПЕРИФЕРИЧЕСКИХ БОЛЕЗНИ, СОСУДИСТЫЕ БОЛЕЗНИ ПЕРИФЕРИЧЕСКИЕ
Korean 상세불명의 말초혈관 질환
Croatian VASKULARNE BOLESTI, PERIFERNE
Polish Angiopatie obwodowe, Choroby naczyń obwodowych
Hungarian Vascularis peripheriás betegség, Peripheriás érbetegség k.m.n., Környéki ér eredetű betegség k.m.n., Betegség, peripheriás vascularis, Peripheriás vascularis betegség, Peripheriás érbetegség, Peripheriás ér eredetű betegség, Keringési elégtelenség, periphériás, Peripheriás vascularis kór, nem meghatározott
Norwegian Perifere kar, sykdommer, Perifere vaskulære sykdommer, Perifere angiopatier, Sykdommer i perifere kar
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Iliac artery stenosis (C0729847)

Concepts Anatomical Abnormality (T190)
SnomedCT 312496009
English iliac artery stenosis (diagnosis), iliac artery stenosis, Iliac artery stenosis, Iliac artery stenosis (disorder)
Czech Stenóza arteria iliaca
Dutch arteria iliaca stenose
French Sténose de l'artère iliaque
German Stenose der arteria iliaca
Hungarian Arteria iliaca stenosis
Italian Stenosi dell'arteria iliaca
Japanese ﾁｮｳｺﾂﾄﾞｳﾐｬｸｷｮｳｻｸ, 腸骨動脈狭窄
Portuguese Estenose da artéria ilíaca
Spanish Estenosis de las arterias iliacas, estenosis de arteria ilíaca (trastorno), estenosis de arteria ilíaca
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Femoral arterial stenosis (C0853255)

Concepts Pathologic Function (T046)
English Femoral arterial stenosis, Femoral artery stenosis
Czech Stenóza stehenní tepny, Stenóza arteria femoralis
Dutch arteria femoralis stenose
French Sténose de l'artère fémorale
German Stenose der Femoralarterie, Stenose der Arteria femoralis
Hungarian Arteria femoralis stenosis, Arteria femoralis stenosisa
Italian Stenosi di arteria femorale, Stenosi dell'arteria femorale
Japanese 大腿動脈狭窄, ﾀﾞｲﾀｲﾄﾞｳﾐｬｸｷｮｳｻｸ
Portuguese Estenose da artéria femoral
Spanish Estenosis de la arteria femoral
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Claudication (finding) (C1456822)

Definition (NCI_FDA) Limping or lameness.
Definition (CSP) limping or lameness.
Concepts Disease or Syndrome (T047)
SnomedCT 195312007, 275520000, 16973004
English Lameness, Limping, Claudication (finding), claudication, CLAUDICATION, Claudication
Dutch claudicatio
French Claudication
German Claudicatio
Italian Claudicazione
Portuguese Claudicação
Spanish Claudicación, claudicación (hallazgo), claudicación
Japanese 跛行, ﾊｺｳ
Czech Klaudikace
Hungarian Claudicatio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Atherosclerosis of artery (C2711237)

Concepts Disease or Syndrome (T047)
SnomedCT 441574008
English Atherosclerosis of artery, Atherosclerosis of artery (disorder), Atherosclerosis artery
Spanish ateroesclerosis arterial, aterosclerosis arterial (trastorno), aterosclerosis arterial
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Femoropopliteal stenosis (C2721556)

Concepts Pathologic Function (T046)
English Femoropopliteal stenosis
Czech Femoropopliteální stenóza
Dutch femoropopliteale stenose
French Sténose fémoro-poplitée
German Femoropopliteale Stenose
Hungarian Femoro-poplitealis stenosis
Italian Stenosi femoro-popliteale
Japanese 大腿膝窩動脈狭窄, ﾀﾞｲﾀｲｼｯｶﾄﾞｳﾐｬｸｷｮｳｻｸ, ﾀﾞｲﾀｲｼﾂｶﾄﾞｳﾐｬｸｷｮｳｻｸ
Portuguese Estenose femoropoplítea
Spanish Estenosis femoropoplítea
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Cardiovascular Medicine

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