It is known as acute limb ischemia to the sudden interruption of blood supply to a limb. Peripheral vascular disease symptoms characterized by the appearance of severe pain, paleness, cold skin, loss of function, together with the absence of distal pulses. It is a life threatening emergency requiring prompt treatment.

The chronic limb ischemia occurs due to slow and progressive decrease in blood flow and therefore oxygen supply to the muscle groups of the lower limbs during exercise. The development of collateral circulation to the ischemic tissue can not be experienced until blockage exceeds 70% of vessel lumen, thus showing cardinal symptom of this disease is intermittent claudication (muscle pain during walking that subsides with rest). The disease progression is slow, with a risk of amputation of 1% per year and an intervention rate of critical ischemia between 6-10% per year.

Peripheral artery disease is four times more common in men, appearing in them about 10 years earlier than women (Estevan Solano JM, 2000).

In the case of acute ischemia may be embolic origin from a point or cardiogenic acute arterial thrombosis in patients with atherosclerotic disease.

Atherosclerosis is the most common cause in most cases of chronic ischemia. It is associated with the presence of known risk factors, which can be classified as follows: coded (Age, male gender, genetic load), and modifiable (Snuff, diabetes mellitus, hypertension, dyslipidemia, obesity, physical inactivity, hyperhomocysteinemia, elevated lipoprotein A and hypercoagulable conditions) that are common to most cardiovascular diseases.

How is it diagnosed?

Anamnesis: A detailed history followed by a complete physical examination are the cornerstones in the diagnosis of peripheral vascular disease (Diaz Sanchez S, 2001, McGee SR, 1998) should be asked about family and personal history, as well as by the presence of vascular risk factors.

The main symptom of this disease is pain. The pain of chronic ischemia occurs gradually with walking, is intense, he stops walking and goes away with rest (intermittent claudication). The distance of travel from the one usually constant, and is shortened to a slope or up stairs. In acute ischemia, the onset of pain is sudden and does not go away with rest. Depending on the location of pain can be known vascular territory affected:

* Posterior aspect of the leg: occlusion of femoropopliteal artery at or above.
* Buttock, hip or thigh, sometimes associated erectile dysfunction in men: occlusion aorto-iliac level or the common femoral.

The chronic form is classified into four stages that indicate the severity of arterial obstruction

Stadium:
I Asymptomatic
II Intermittent claudication
II-a More than 150 meters
II-b Less than 150 meters
III Rest pain or night
IV Trophic lesions, necrosis or gangrene

The differential diagnosis includes processes musculo-skeletal, vascular and neurological. Compression cauda equina by spinal canal stenosis is manifested by pain radiating to both legs that is exacerbated or appears to exercise does not improve with rest, but may even worsen prolonged standing (Gey DC, 2004)

Physical examination includes inspection and palpation, and thus extremely cold and pale when elevated, with a time of greater than 20 seconds redness or venous filling more than 30 seconds after the end boost, along with the presence of tropic disorders Skin ulcers are indicative of arterial obstruction (NE Stoffers, 1997).

Palpation of arterial pulses forms the basic examination for the diagnosis of this disease presence of distal pulses in an extremity pathology excluded. The presence of distal pulses does not exclude pathology ischemic patients with typical clinical, being necessary to the achievement of studies. A distinction should be the patient’s pulse, heartbeat of fingers of browser, for which you can compare patient’s pulse with his heartbeat radial like to avoid describing pulse as this is felt or not. This exploration requires training because there is great variability interexplorador, and must be systematically including all arterial territories accessible.