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Peripheral Vascular Disease

Peripheral Vascular Disease

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Peripheral Vascular Disease

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  1. Peripheral Vascular Disease Valerie Robinson D.O.

  2. Peripheral Vascular Disease AKA Peripheral Artery Disease • AKA Arteriosclerosis Obliterans • Caused by atherosclerosis • Arterial walls lose compliance • Is usually progressive • May occlude medium and large arteries • Vascular disease may manifest acutely when thrombi, emboli, or acute trauma compromisesperfusion. • Risk factors • Dyslipidemia • Diabetes • CAD • HTN • Renal failure • Smoking • Hx of CVA or MI

  3. Symptoms • Most commonly found in the lower extremities • Claudication – worse when walking fast, uphill, or for a long distance • Aortoiliac disease manifests as pain in the thigh and buttock, whereas femoral-popliteal disease manifests as pain in the calf • Slow healing • Poor circulation (pale, cool feet) • Raynaud’s phenomenon • Ulcers and/or Gangrene • Neuropathy • Night-time leg cramps • Pain gets better when leg is hanging • Lerichesyndrome is a clinical syndrome described by intermittent claudication, impotence, and significantly decreased or absent femoral pulses.

  4. Diagnosis: Physical Exam • Peripheral signs of peripheral vascular disease are the classic "5 P's": • Pulselessness • Paralysis • Paraesthesia • Pain • Pallor • Ankle-brachial index • Bruits • Loss of hair on legs and feet, skin becomes pale and shiny • Atrophied muscles, especially calf • Ulcers • Cyanosis/paleness

  5. Diagnosis: Tests • Ankle-Brachial Index (ABI) • BPankle/BPbiceps • If <0.9, mild PAD. • Between 0.5 and 0.9 is moderate dz with claudication • If <0.5, severe PAD often has gangrene or ulcers • Doppler • Angiography, MRA, or CTA

  6. Before and after stent

  7. Treatment • Increase exercise, but allow time for rest • Control risk factors such as smoking, HTN, lipids, DM • Anti-platelet drugs: aspirin, Plavix (clopidogrel) • Phosphodiesterase inhibitors: Trental (pentoxifylline), Pletal (cilostazol) • Statins • Amputation, ABI<0.3 • Angioplasty with stents • Bypass

  8. References • “Peripheral artery disease – legs.” A.D.A.M. Medical Encyclopedia. PubMed Health. U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/. Updated May 14, 2012 • “Doppler assessment and ABPI: Interpretation in the management of leg ulceration.” World Wide Wounds. http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html • Stephens, Everett MD. “Peripheral Vascular Disease.” Medscape. http://emedicine.medscape.com/article/761556-overview#showall Updated March 15 2010.