Peripheral arterial disease

Question 1

what is the definition of PAD?

Answer 1

Peripheral arterial disease (PAD) includes a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.

Question 2

what is the epidemiology of PAD?

Answer 2

Increased with age

Question 3

what is the aetiology of PAD?

Answer 3

PAD is most commonly caused by atherosclerosis. Rarer causes of claudication are aortic coarctation, arterial fibrodysplasia, arterial tumour, arterial dissection, arterial embolism, thrombosis, vasospasm, and trauma.

Question 4

what are the risk factors for PAD?

Answer 4

Smoking
Diabetes
Hypertension 
Hyperlipidaemia
Age more than 40
History of CAD
Low level of exercise

Question 5

what is the pathophysiology of PAD?

Answer 5

damage, inflammation, and structural defects of blood vessels. It includes atherosclerosis, degenerative diseases, dysplastic disorders, vascular inflammation, and thrombosis as well as thromboembolism.

Question 6

what are the key presentations of PAD?

Answer 6

Presence of risk factors
Asyotomsatic 
Intermittent claudication 
Thigh orbuttock pain while walking 
Diminished or absent pulse 
Sudden onset of severe leg pain

Question 7

what are the signs of PAD?

Answer 7

Risk factors

Diminished pulse

Question 8

what are the symptoms of PAD?

Answer 8

Asymptomatic
Thigh buttock or leg pain
Erectile dysfunction
Muscle atrophy

Question 9

what is the first line and gold standard investigation for PAD?

Answer 9

Ankle brachial artery index (ABI) - <0.9

Question 10

what are the differential diagnoses for PAD?

Answer 10

Spinal stenosis
Arthritis
Venous claudication

Question 11

how is PAD managed?

Answer 11

Acute: 
Urgent assessment for amputation 
Antiplatelet therapy 
Analgesia
Anticoagulation 
Endovascular revascularization 
Surgical revascularization 
Amputation
Claudication: 
Not limiting - anti platelet therapy, exercise, RF mods 
Limiting - anitplatly, exercise, symptom relief, RF mods, revascularization

Question 12

how is PAD monitored?

Answer 12

For those patients who have PAD who are not functionally limited, an annual follow-up visit to monitor for development of coronary, cerebrovascular, and extremity disease is warranted. For patients with PAD with lifestyle-limiting claudication who benefited from conservative treatment, annual visits are recommended.

Question 13

what are the complications of PAD?

Answer 13

Leg and foot ulcers
Gangrene
Permanent limb weakness
Periminant limb pain

Question 14

what is the prognosis of PAD?

Answer 14

Morbidity and mortality related to cause