1. Peripheral Arterial Disease CST teaching Wissam Al-Jundi ST3 Vascular Surgery 01/12/2009

2. PAD Symptoms • Intermitted Claudication • Distance walked before onset of pain/has to stop • Location • calf, thigh, buttock • Ischaemic rest pain: • Severe, unremitting affects toes and MTs • Eased by dependency • Pain experienced on lying flat • Patient usually sleeps in a chair

3. PAD - Risk factor modification • To alleviate disability • To prevent major amputation • To reduce the secondary morbidity • Cardiac • Stroke

4. PAD - Risk factor modification • Smoking cessation1 • Treatment of Hyperlipidaemia2 • Diabetic control3 • Control of Hypertension4 • Anti-platelet therapy5 • Diet – Fish oils6 • Exercise programmes7 • Others: hyperhomocysteinaemia8

5. Risk factor modification – smoking cessation • 70% of POAD patients continue to smoke • Improvement in claudication in 3-6 months • Reduced risk of critical ischaemia • Reduced MI and mortality • 5-10 years future cardiovascular risk approaches non-smokers

6. Risk factor modification - hyperlipidaemia

7. Risk factor modification – anti-platelet therapy

8. Risk factor modification - Clopidogrel

9. Risk factor modification: Exercise

10. Critical limb ischaemia - definition

11. Angioplasty

12. Angioplasty + stenting

13. Indications for intervention

14. Acute limb ischaemia

15. Acute limb ischaemia