Peripheral Arterial Occlusive Disease (Corbett) - 11/15/16

Question 1

What is peripheral arterial occlusive disease?

Etiology?

Answer 1

Presence of flow-limiting lesion in artery that provides blood supply to the limbs

Etiology:

• Atherosclerosis (most common) - usually a stenotic lesion
• Thromboembolism
• Vasculitis

15-20% of patients over age of 70 (disease of older individuals)

Question 2

Clinical Presentation (3)

Answer 2

• Pain w exertion (claudication)
  
  • Most common clinical manifestation of peripheral arterial disease
  • LE > UE
• Rest pain
• Non-healing wounds
  
  • Blood supply insufficient for healing

Question 3

What is intermittent claudication?

Answer 3

“Reproducible ischemic muscle pain” that occurs during physical activity and is relieved after a short rest

• Pain reproducible within same muscle groups
• Pain ceases w resting period of 2-5 min (even just w standing in place)

Important to quantify

• Is it predictable?
• If they stop activity, does pain go away?

Question 4

What is neurogenic claudication?

Answer 4

• Spinal stenosis
• Progressive narrowing of the spinal canal
• Pain relieved when patient flexes the spine by sitting

vs

Pain due to vascular claudication stops quickly when you rest, even in the standing position.

Question 5

Location of pain correlates with affected artery (2)

Answer 5

• Disease in distal superficial femoral artery most common
  
  • Claudication - calf muscle
• Disease in aortoiliac area
  
  • ​Claudication - thigh and buttock
  • Male erectile dysfunction common

Question 6

Risk factors and pathology of PAD identical to CAD (5)

Answer 6

1. HTN
2. Hyperlipidemia
3. Smoking
4. DM
5. Family hx

Question 7

Physical Exam (4)

Answer 7

1. Complete LE eval and pulse exam
2. Listen for bruits (renal, iliac, femoral)
3. Palpate pulses
   
   1. Femoral
   2. Popliteal
   3. Posterior tibial
   4. Dorsalis pedis
4. Measure segmental pressures (ABI)
   
   1. Ankle-Brachial Index (1.0-1.4 is normal… less than 0.5 = limb threatening or tissue threatening ischemia)
5. Dependent rubor?
6. Atrophy of calf muscles?

Question 8

Acute Limb Ischemia

Five P’s (EMERGENCY)

Answer 8

• Emboli = most common cause
• Five P’s
  
  • Pain
  • Pulseless
  • Paresthesias
  • Paralysis
  • Poikilothermia (inability to regulate core temp)

Can happen in healthy individual when thrombus gets stuck in an end artery (i.e. popliteal a.)