Which physical findings are characteristic of peripheral arterial occlusive disease (PAOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Palpation of pulses should be attempted from the abdominal aorta to the foot, with auscultation for bruits in the abdominal and pelvic regions. This can be difficult with obese patients, in whom palpable pulses may be hidden under a deep subcutaneous layer.

The absence of a pulse signifies arterial obstruction proximal to the area palpated. For example, if no femoral artery pulse is palpated, significant PAOD is present in the aortoiliac distribution. Similarly, if no popliteal artery pulse can be palpated, significant superficial femoral artery occlusive disease exists. The exception is the rare case of a congenital absence of a pulse (eg, persistent sciatic artery).

Patients who report intermittent claudication and have palpable pulses can present a clinical dilemma. If the history is consistent with typical claudication symptoms, the clinician can have the patient walk around the office (or perform toe raises) until the symptoms are reproduced and then palpate for pulses. The exercise should cause the atherosclerotic lesion to become significant and should diminish the strength of the pulses distal to the lesion.

When palpable pulses are not present, further assessment of the circulation can be made with a handheld Doppler device. An audible Doppler signal assures the clinician that some blood flow is perfusing the extremity. If no Doppler signals can be heard, a vascular surgeon should be consulted immediately.


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