A Review of Peripheral Vascular Disease*
The modern conception of peripheral vascular disease has been clarified to a considerable degree during the past decade by a better understanding of the physiology of the arterioles and capillaries. Hundreds of articles have been published by various investigators who have made intensive studies of the peripheral circulation in animals and in man. As the result of this work, a much better classification has been evolved, which is based on special diagnostic tests and on the results of medical and surgical therapy.
The picture of peripheral vascular disease is very complicated. While the most frequently encountered conditions are Buerger’s disease, arteriosclerosis, embolism and thrombosis, Raynaud’s disease, erythromelalgia, and acrocyanosis, many other morbid changes may occur in the peripheral circulation and these merit thoughtful attention.
How shall we attack this problem? It is evident that the first consideration must deal with the patient as a whole. Is he well nourished or does he suffer from malnutrition and deficiency disease? Does he have arterial hypertension or hypotension, arteriosclerosis or diabetes? Is he suffering from rheumatic, syphilitic, or arteriosclerotic heart disease? Does he carry executive responsibilities? What are his habits of living? Is he intemperate in the use of alcohol and tobacco? These and many other questions must be settled by means of a painstaking history, physical examination, and laboratory tests. Our first approach, then, must consist of a careful survey of the patient as a whole. This procedure alone will, in many instances, suggest the type of peripheral vascular disease. . .