Peripheral Vascular Diseases PDF

Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases...

Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Peripheral Vascular Diseases TereAnthony C. Abella, MD IM-2 San Beda College of Medicine Arterial Disorders  Peripheral Artery Disease Encompasses disorders of the arterial circulation of upper and lower extremities, aortic disease, cerebrovas-cular and carotid artery disease, mesenteric and renovascular disorders, disorders of the microcirculation. Peripheral vascular disease Refers to the totality of arterial, venous, and lymphatic disorders.  Peripheral Artery Disease Most frequently caused by atherosclerosis Nonatherosclerotic PAD may result in progressive arterial stenosis or aneurysm formation. ominous trio of atherosclerotic vascular disorders coronary artery disease (CAD) Cerebrovascular disease (CVD) Peripheral artery disease (PAD)  Peripheral Artery Disease 2 atherosclerotic Lower ext subtypes Proximal Female sex, smoking, hypertension, dyslipidemia Distal Older people, males, smoking history, diabetes  Disease Burden Prevalence of PAD among people aged >25y/o 5.56% national community-based prevalence rate of PAD among Filipinos aged 20 years and older 5% high-risk patients aged 40 years and older and who have a history of myocardial infarction or ischemic stroke, 31.7%  Risk Factors Traditional risk factor: Smoking*** Diabetes *** Age Dyslipidemia Hypertension Family history Community based study among Filipinos Female gender Elevated LDL Low BMI  CLINICAL PRESENTATION: History 4 different Asymptomatic, but physical findings consistent with PAD Chronic limb ischemia Critical limb ischemia / chronic limb-threatening ischemia Acute limb ischemia  Asymptomatic, but physical findings consistent with PAD Majority of patients Of those newly diagnosed with PAD 48% asymptomatic 46% Atypical exertional leg pain 6% classic intermittent claudication Worse quality of life and limb function Progression to advanced disease Heightened risk of cardiovascular morbidity and mortality  Chronic Limb Ischemia Classic Intermittent Claudication exertional leg pain or discomfort, cramping or tiredness in the leg or hip muscles occurs during physical effort or exercise like Walking/ running climbing up the stairs relieved in a few minutes with rest  Critical limb ischemia / chronic limb-threatening ischemia 0.3-2% Manifests as: ischemic rest pain tissue loss non-healing wounds ulcers gangrene duration greater than 2 weeks associated with an increased risk for Mortality limb loss poor health-related quality of life  Acute Limb Ischemia sudden decrease or cessation of arterial flow to the extremity within the last two weeks immediate threat to the viability of the limb "6 P’s” Pain Pallor Pulselessness paresthesia, paralysis, and poikilothermia "perishing cold" or cold "polar" sensation.  CLINICAL PRESENTATION: Physical Examination Relatively poor sensitivity and specificity for PAD Highly spcecific findings Abnormal dorsalis pedis Abnormal posterior tibial artery pulses Unilaterally cool extremity Femoral bruit Burger’s test Neurologic Diabetic peripheral neuropathy (DPN)  CLINICAL PRESENTATION: Physical Examination Arterial ulcer Tips of toes “punched out” appearance Neuropathic/neurotrophic ulcers pressure or friction points over bony prominences or in the sole of the feet, near calluses. Seen in patients with longstanding diabetes Results from loss of protective sensation.  Diagnostic Testing Ankle-brachial index Non-invasive tool for the assessment of vascular status Consists of the ratio betweem the systolic blood pressure of the lower extremity and the upper extremity Compares the resistance of the blood vessels (diameter) Prognostic marker of CV events and mortality InterpretationL Normal: 1.0-1.4 Diagnostic for the presence of PAD: 1.4  Prognosis Atherosclertoc PAD is often a polyvascular disease 61% having concomitant involvement in the coonary and cerebrovascular circulation REACH registry PAD patients had highest rates of CVD/MI/ stroke/hospitalization for atherothrombotic event (33.2%) All-cause mortality (13.9%) 78% attributed to cardiovascular events 5 year risk for LEA (~5%)  TREATMENT: Acute Limb ischemia  TREATMENT: Acute Limb ischemia Time is limb Urgency of treatment is dictated by the severity of ALI ischemia reperfusion injury (IRI) revascularization Long term therapeutic anticoagulation (minimum 3 months)  TREATMENT: Acute Limb ischemia  TREATMENT: Chronic Limb Ischemia Lifestyle changes: smoking cessation, statin therapy, LDL-C < 55 mg/di HDL-C target > 40 mg/dl in males > 50 mg/di in females, triglyceride target < 150 mg/d anti-hypertensive therapy