degrees of severity/pt presentation
- Asymptomatic (can be due to concomitant neuropathy or earlier stages of disease)
- Symptoms
- Acute limb ischemia
- Critical limb ischemia
- Tissue loss
- Amputation
- PAD marker for systemic vascular disease. If identified in one part of the body, must check others to rule out.
- Symptoms
a. Atypical leg pain
b. Diminished pulses
c. Dependent rubor
d. Pallor on elevation
e. Absence of hair growth
f. Dystrophic nails
g. Cool, dry, fissured skin
h. Claudication: fatigue, discomfort, cramping or pain of vascular origin in the muscles of the lower extremities consistently induced by exercise and consistently relieved by rest (within 10 minutes)
- Acute limb ischemia
a. <2 weeks, 6 P’s: pain, pallor, pulselessness, poikilothermia, paresthesias, paralysis
- Critical limb ischemia
a. >2 weeks, with ischemic rest pain, nonhealing would/ulcers, gangrene
- PAD marker for systemic vascular disease. If identified in one part of the body, must check others to rule out.
a. Renal
b. Abdominal Aortic Aneurysm (AAA)
c. Coronary
d. Carotid
e. Subclavian
f. mesenteric
Abnormal (PAD)
<0.9
Borderline
0.91-0.99
Normal
1-1.4
Noncompressible
> 1.4
treatment pearl (warfarin)
- The use of warfarin should be avoided in PAD due to lack of proven benefit and increased risk of bleeds.
treatment pearl (symptomatic relief)
- Symptomatic relief
• Pain: cilostazol
• Ulcers healing: Unna paste
• Edema: compression stockings
treatment pearl (CV risk reduction)
- Use statins, ACE inhibitors, and antiplatelet agents to reduce CV risk
treatment pearl (dual?)
- Dual antiplatelet therapy (ASA + clopidogrel) does not have established effectiveness
treatment pearl (refer)
- Refer to vascular surgeon for revascularization if claudication causing significant functional impairment after adequate medication trial or presence of disease that would impair ability to exercise even with claudication improvement (angina, HF, asthma/COPD)
treatment pearl (refer-abi)
- Refer to vascular surgeon if ABI < 0.4, absence of pedal flow, signs of CLI
treatment pearl (refer- ED)
- Refer to ED if signs of ALI are present (give heparin upon presentation)
Goals of treatment
- Increase walking time and distance
- Cardiovascular risk reduction: HTN, lipids, diabetes
- Symptomatic relief
- Prevent limb loss
