CHAPTER 36 



Peripheral vascular diseases- 



diseases other than atherosclerosis 1 



GEORGE E. BURCH 

 JOHN PHILLIPS 



Department of Medicine, Tulane University School of Medicine, 

 and Charity Hospital of Louisiana, New Orleans, Louisiana 



CHAPTER CONTENTS 



Vascular Malfunction in General 



Approach of the Clinician and Clinical Physiologist to the 

 Study of Patients with Diseases of the Peripheral Circula- 

 tion 

 The History 



Symptoms of arterial disease 

 Symptoms of venous disease 



Manifestations of capillary and lymphatic disease 

 The Physical Examination and Simple Clinical Tests of 

 Vascular Function 

 Determination of the adequacy of the cutaneous circula- 

 tion 

 Evaluation of the status of the main arteries 

 Evaluation of the status of the venous system 

 Evaluation of the status of capillary and lymphatic vessels 

 Special Laboratory Procedures for Examining the Peripheral 

 Circulation 

 Effects of Circulatory Arrest 

 Classification of Peripheral Vascular Disease 

 Mechanisms in Peripheral Vascular Disease 

 Vasoconstrictor Disease Syndromes 

 Raynaud's syndrome or phenomenon 

 Acrocyanosis 

 Livedo reticularis 

 Causalgia and related syndromes 

 Miscellaneous states 

 Vasodilative Syndromes 



Erythromelalgia (erythermalgia) 

 Mechanisms in Other Vascular Diseases 

 Appendix 



one of the great interests in the vascular system 

 is its reaction and response to disease. Although most 



1 Work supported by grants from the L'. S. Public Health 

 Service. 



physiologic studies have been concerned with the 

 normal state, the pathophysiology of vascular disease 

 is of considerable importance to the physiologist and 

 the clinician. Attempts will be made in this chapter 

 to correlate the interactions of vascular malfunction 

 with the pathologic lesions and their clinical mani- 

 festations. The presentation will be limited primarily 

 to diseases of and observations on man. 



In the discussions to follow the term "peripheral 

 vascular disease" will refer to disease affecting largely 

 the circulation to the limbs. This obviously excludes 

 a discussion of disease in other circulatory beds; 

 notable among these sites are the pulmonary, portal, 

 renal, and cerebral vessels. Further, the discussions 

 will be limited in large part to "primary" vascular 

 disease, or disease states in which alterations in blood 

 vessels and their function are the basic cause for the 

 disease manifestations. Vascular changes associated 

 with or secondary to primary disease in other organs 

 are important but they are beyond the scope of this 

 presentation. Examples of these secondary vascular 

 disturbances are the spider angiomata and palmar 

 erythema occurring in liver disease, aging, rheumatoid 

 arthritis, and pregnancy; the pale avascular skin of 

 castrate and eunuchoid men; the reddish flushes of 

 the menopausal states; the cyanotic flushes of seroto- 

 nin-producing carcinoids; the pallor of the nephrotic 

 syndrome, hypothyroidism, and pituitary insuffi- 

 ciency; the vasoconstriction of pheochromocvtomas; 

 the vasodilatation of thyrotoxicosis; the vascular 

 changes of acute exanthema, scarlet fever, and other 

 infectious diseases; and the digital clubbing and 

 cyanosis of cardiac and pulmonary disease. 



1215 



