Peripheral Artery Disease Flashcards
Définition
narrowing or blockage of the peripheral arteries (virtually always lower) causing ischemia.
Causes
vasculitis
buerger’s disease
atherosclerosis ( common )
Main arteries affected
aorto-illiac arteries
intrainguinal arteries.
Incidence in men and women
7% of middle aged men and 4.5% of middle aged women.
Prognosis
good prognosis but patients usually die of myocardial infarction complications or stroke.
Etiology
• Smoking
• Diabetes
• Age
• Hypertension
• Infection
• Obesity
Parhogenesis
Narrowing of artery -> decreased blood flow -> ischemia -> release of NO -> vessel damage -> claudication
Spectrum of symptoms of PAD
Asymptomatic
Pain
Ache
Tiredness
Tightness
Rest pain, poor wound healing , impending or overt gangrene when severe
Clinical features
• Intermittent claudification
Ischemic muscle pain usually felt in the calf Typically pain con
• Critical limb ischemia
Rest pain requiring opiate analgesia
Gangrene present for 2 weeks
Presence of ankle BP less than 50mmHg
• Acute limb ischemia
Paralysis and paresthesia
Pain on squeezing calf
Symptom
Pan
Pallor
Pulselessn
Perishing
• Atheroembolism -> Blue fingers
Paraesthes
Paralyses
• Subclavian steal
Dizziness
Cortical blindness
6 Ps in PAD
Pain
Paresthesia
 Incidence
20% of individuals 55 to 75 years
Most common symptom of the PAD
Intermittent claudication
Percentage of patients that’s progress to a point where amputation or revascularization are required
1 to 2%
Cause of death in PAD
Myocardial infarction
stroke
Percentage of patients with PAD that have diabetes
5 to 10%
Particular mechanism of PAD in patient with diabetes
Atheroma formation affecting medium size to large arteries rather than obstructive microangiopathy
Which part of the body is mostly affected by PAD
The legs eight time more than the arms
Main vessel affected by PAd
Aortoiliac vessels
Femoropopliteal vessels
Infra-popliteal vessels
Subclavian artery in the arm
Clinical features of PAD
Intermittent claudication
Critical limb ischemia
Acute limb ischemia
Atheroembolism,
subclavian steal
Characteristics of intermittent claudication
Pain after walking and rapidly subsides on resting
What is critical limb ischemia?
Rests pain requiring opiateanalgesia, and/or ulceration/ gangrene that has been present more than two weeks with ankle BP less than 50 mmHg
Types of peripheral vascular disease in diabetes
Arterial calcification
Immunocompromise
Multisystem arterial disease
Distal disease
Sensory neuropathy
Motor neuropathy
Autonomic neuropathy
Six P’s of acute limb ischemia
Pain
Pallor
Pulselessness
Perishing cold
Paraesthesia
Paralysis
What is a atheroembolism ?
Small emboli lodging in small arteries getting to blue fingers in general
What is subclavian steal?
Dizziness, cortical blindness, and collapse, due to diversion of blood from the brain to the limbs, especially the arms via the vertebral artery
Investigation
Clinical exam
ankle brachial pressure index
Duplex ultrasonography
MRI,
CT with contrast,
lipid profile
blood glucose
How do you find the ankle brachial pressure index?
Divide highest systolic ankle blood pressure to the highest systolic brachial blood pressure
Classification of ankle brachial pressure index
Over 1.0 - healthy
0.5 to 0.9 - l’intermittent claudication
Less than 0.5. - critical limb ischemia
Management
Smoking cessation
regular exercise
anti-platelet agents ( aspirin, clopidogrel )
reduction of cholesterol with statins, diet , weight loss
treatment of diabetes mellitus
associated conditions treatment ( hypertension, anemia, heart failure )
What is the buergers disease?
Inflammatory disease of arteries, present in young male smokers, which affect distal arteries with claudication in the feet ,or rest pain in the fingers or toes ,with absent wrist and ankle pulses
What is raynaud syndrome?
He’s order affecting young women with blue color in cold temperatures
