Absence or decrease in peripheral arterial pulses

Specialty: Cardiovascular.

• weak peripheral pulses
• abolition of distal pulses
• peripheral hyposphygmia

Why it occurs

• Atherosclerotic occlusive peripheral artery disease
• Acute arterial occlusion of embolic or thrombotic origin
• Acute aortic dissection (with spread and involvement of the main arterial branches)
• Coarctation of the aorta (femoral-radial decrease or delay)
• Large vessel vasculitis (such as Takayasu arteritis or giant cell arteritis)
• Extrinsic arterial compression or popliteal artery entrapment syndrome

Initial workup

Determination and recording of the Ankle-Arm Index (ABI); Arterial Doppler ultrasound of the affected limb to observe vascular permeability and flow wave morphology (loss of the physiological triphasic wave); Whole-body computed tomography angiography (CT-Angio) if aortic dissection or proximal occlusive pathology is suspected; Diagnostic arteriography.

Standard management

• Unfractionated heparin — immediately indicated in suspected acute arterial occlusion to prevent the spread of the thrombus; intravenous bolus of 80 IU/kg followed by continuous infusion adjusted according to aPTT between 1.5 and 2.5 times the control value
• Alprostadil — prostaglandin E1, indicated in critical ischemia of non-revascularizable lower limbs to induce vasodilation and microvascular antiaggregation; 40 to 60 mcg as a slow 2-hour intravenous infusion
• Atorvastatin — statin for the management of underlying atherosclerotic arteriopathy; 40 mg once daily orally
• Enalapril (to control high blood pressure if it is associated with obstructive vasculopathy, monitoring kidney function; 5 to 10 mg per day orally).