Peripheral arterial disease - (also covered in cardio) Flashcards
What is peripheral arterial disease (PAD) strongly linked to?
PAD is strongly linked to smoking. Patients who still smoke should be given help to quit smoking.
What comorbidities should be treated in patients with PAD?
Comorbidities that should be treated include hypertension, diabetes mellitus, and obesity.
What medication is recommended for all patients with established cardiovascular disease?
All patients should be taking a statin, with atorvastatin 80 mg currently recommended.
What did NICE publish in 2010 regarding antiplatelet therapy for PAD?
NICE suggested that clopidogrel should be used first-line in patients with PAD in preference to aspirin.
What is recommended for patients with PAD prior to other interventions?
NICE recommends a supervised exercise programme for all patients with PAD prior to other interventions.
What are the treatment options for severe PAD or critical limb ischaemia?
Treatment options include endovascular revascularization, surgical revascularization, and amputation if not suitable for other interventions.
What are the endovascular techniques used for?
Endovascular techniques are typically used for short segment stenosis (e.g. < 10 cm), aortic iliac disease, and high-risk patients.
What surgical techniques are used for long segment lesions?
Open surgical techniques are typically used for long segment lesions (> 10 cm), multifocal lesions, lesions of the common femoral artery, and purely infrapopliteal disease.
What drugs are licensed for use in PAD?
Drugs licensed for use in PAD include naftidrofuryl oxalate and cilostazol.
What is the function of cilostazol?
Cilostazol is a phosphodiesterase III inhibitor with both antiplatelet and vasodilator effects - not recommended by NICE.
When should amputation be considered in PAD patients?
Amputation should be reserved for patients with critical limb ischaemia who are not suitable for other interventions such as angioplasty or bypass surgery.
