PAD Lecture 2024 PDF

Peripheral Artery Disease Haley O’Neal, PharmD, BCPS Pharmacotherapy II Objectives Describe pathophysiology of peripheral artery disease Identify risk factors and clinical manifestations of peripheral artery disease Describe diagnostic tools used in the diagnosis of...

Peripheral Artery Disease Haley O’Neal, PharmD, BCPS Pharmacotherapy II Objectives Describe pathophysiology of peripheral artery disease Identify risk factors and clinical manifestations of peripheral artery disease Describe diagnostic tools used in the diagnosis of peripheral artery disease Apply principles of peripheral artery disease to select an appropriate therapeutic regimen Introduction Most common form of peripheral vascular disease Narrowing of arteries in the lower extremities due to atherosclerosis Increased risk of cardiovascular disease morbidity and mortality Underdiagnosis and undertreatment worldwide 3rd leading cause of atherosclerotic morbidity Epidemiology Affects more than 200 million people globally 8-10 million Americans Incidence estimated at 10-15% and increases with age >20% in patients >80 years old Likely to have disease in other vascular beds Smoking, DM, HTN, HLD, and impaired renal function associated with more prevalent PAD Pathophysiology Occlusion of arterial lumen by atherosclerotic plaques Arteries commonly affected: Femoral, popliteal, tibial Aortoiliac Carotid and vertebral Splenic and renal Brachiocephalic  Clinical Subsets of PAD ALI: acute limb ischemia CLTI: chronic limb-threatening ischemia  Age Cigarette smoking Diabetes mellitus Risk Factors Hypercholesterolemia Hypertension Impaired renal function Clinical Presentation Variable presentation with no Signs and Symptoms symptoms at all to pain and discomfort Pain, tightness, weakness, or aching that occurs from exertion but relieved with rest Numbness in toes, feet, or lower legs Decreased or absent peripheral pulses Most common characteristics: Leg muscle atrophy Intermittent claudication Hair loss on toes, feet, or lower legs Pain at rest in lower Smooth, shiny skin extremities Cyanosis, cool skin temperature Thick, hardened toenails Peripheral edema Ulceration or gangrene Who Should Be Screened for PAD? Patients at Increased Risk of PAD Age ≥65 Age 50-64, with risk factors* for atherosclerosis, CKD, or FH of PAD Age 10 min rest for pain to resolve Leg weakness, numbness, fatigue during walking without pain Ischemic rest pain Nonhealing lower extremity wound History of nonhealing or slow-healing lower extremity Lower extremity gangrene wound Erectile dysfunction Other findings suggestive of ischemia Asymmetric hair growth, nail bed changes, calf muscle atrophy, elevation pallor Ankle-Brachial Index (ABI) Standard for diagnosis of PAD Measurement of SBP in both brachial arteries and both dorsalis pedis and posterior tibial arteries ABI Measurements 1.0 to 1.4 à normal 0.7 to 0.9 à mild 0.4 to 0.7 à moderate