Disease Valerie Robinson DO Peripheral Vascular Disease AKA Peripheral Artery Disease AKA Arteriosclerosis Obliterans Caused by atherosclerosis Arterial walls lose compliance Is usually progressive ID: 216955
Download Presentation The PPT/PDF document "Peripheral Vascular" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Peripheral Vascular Disease
Valerie Robinson D.O.Slide2
Peripheral Vascular Disease AKA Peripheral Artery Disease
AKA Arteriosclerosis
Obliterans
Caused by atherosclerosis
Arterial walls lose compliance
Is usually progressive
May occlude medium and large arteries
Vascular disease may manifest acutely when
thrombi
, emboli, or acute trauma
compromises
perfusion.
Risk factors
Dyslipidemia
Diabetes
CAD
HTN
Renal failure
Smoking
Hx
of CVA or MISlide3
Symptoms
Most commonly found in the lower extremities
Claudication – worse when walking fast, uphill, or for a long distance
Aortoiliac disease manifests as pain in the thigh and buttock, whereas femoral-popliteal disease manifests as pain in the calfSlow healingPoor circulation (pale, cool feet)Raynaud’s phenomenonUlcers and/or GangreneNeuropathyNight-time leg crampsPain gets better when leg is hanging
Leriche
syndrome is a clinical syndrome described by intermittent claudication, impotence, and significantly decreased or absent femoral pulses. Slide4
Diagnosis: Physical Exam
Peripheral
signs of peripheral vascular disease are the classic "5 P's":
PulselessnessParalysisParaesthesiaPainPallorAnkle-brachial indexBruitsLoss of hair on legs and feet, skin becomes pale and shiny
Atrophied muscles, especially calf
Ulcers
Cyanosis/palenessSlide5
Diagnosis: Tests
Ankle-Brachial Index (ABI)
BPankle
/BPbiceps If <0.9, mild PAD.Between 0.5 and 0.9 is moderate dz with claudicationIf <0.5, severe PAD often has gangrene or ulcersDopplerAngiography, MRA, or CTASlide6Slide7
Before and after stentSlide8
Treatment
Increase exercise, but allow time for rest
Control risk factors such as smoking, HTN, lipids, DM
Anti-platelet drugs: aspirin, Plavix (clopidogrel)Phosphodiesterase inhibitors: Trental (pentoxifylline), Pletal (cilostazol)
Statins
Amputation, ABI<0.3
Angioplasty with stents
BypassSlide9
References
“Peripheral artery disease – legs.” A.D.A.M. Medical Encyclopedia. PubMed Health. U.S. National Library of Medicine. http
://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223
/. Updated May 14, 2012“Doppler assessment and ABPI: Interpretation in the management of leg ulceration.” World Wide Wounds. http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.htmlStephens, Everett MD. “Peripheral Vascular Disease.” Medscape. http://emedicine.medscape.com/article/761556-overview#showall Updated March 15 2010.