An Ocular Study of Pulseless Disease

Abstract

Pulseless disease, an extreme and dramatic form of chronic circulatory insufficiency, was first described by Robert Adams in 1827.1It is characterized clinically by the absence of detectable pulses and inability to measure blood pressure in the arms and neck. Pathologically there is obstruction of the major blood vessels arising from the arch of the aorta. The principal synonyms are the arch syndrome, the reverse coarctation syndrome, the chronic subclaviancarotid obstruction syndrome, obliterative brachiocephalic arteritis, thromboarteritis obliterans subclaviocarotica, ophthalmoangiopathic hypotonica, Martorell's syndrome, and Takayasu's disease. The term aortic arch syndrome has gained some recent favor but we have elected to continue the term pulseless disease because it is simpler, older, more frequently used, and because the vascular obstruction need not necessarily be at the arch. Despite the absence of palpable pulses even where the artery itself is palpable, small pulsations have been demonstrated in some patients by