exam in PAD

Q: 72 years old male with long standing history of smoking presented with acute pain in upper calf area. The suspected artery is? ( select one)

A) superficial femoral artery 

B) popliteal artery

Answer: A

The objective of this question is to highlight the importance of history taking and physical exam in peripheral vascular disease. Patient symptoms and area of pain/claudication provide enough clue of probable involved vessels. Few examples are:

• buttock and hip claudication – aortoiliac disease  
• thigh claudication – common femoral artery
• upper 2/3rd calf claudication – superficial femoral artery 
• lower third of the calf - popliteal disease
• foot claudication – tibial and peroneal vessels

70 years ago when diagnostic imaging were not available, a physical exam determined the diseased vessel.  

#vascular

#physical-exam

#surgical-critical-care

References:

1. Leriche R, Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg 1948; 127:193.

2. Armstrong DW, Tobin C, Matangi MF. The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease. Can J Cardiol. 2010 Dec;26(10):e346-50. doi: 10.1016/s0828-282x(10)70467-0. PMID: 21165366; PMCID: PMC3006105.

3. Rajamanickam A, Krishnan P. History and Physical Examination in Diagnosis of Peripheral Artery Disease. Interv Cardiol Clin. 2014 Oct;3(4):461-467. doi: 10.1016/j.iccl.2014.06.007. Epub 2014 Oct 2. PMID: 28582072.