Difference between revisions of "Peripheral artery disease"

(Source)
(Treatment)
Line 42: Line 42:
 
==Treatment==
 
==Treatment==
 
Acute Limb Ischemia
 
Acute Limb Ischemia
*Unfractionated Heparin
+
*[[Unfractionated Heparin]]
 
**80 units/kg bolus; then infuse 18units/kg/hr
 
**80 units/kg bolus; then infuse 18units/kg/hr
 
*ASA
 
*ASA

Revision as of 05:58, 21 March 2014

Background

  • Peripheral artery disease = ABI <0.9
  • >80% of pts are either former or current smokers
  • 33% of deaths are from reperfusion injury
    • Myoglobinemia, ARF, incr CK
  • Thrombosis accounts for >80% of lower limb ischemia

Diagnosis

History

  • 6 P's: Pain, pallor, paralysis, pulselessness, paresthesias, polar
    • Paresthesia and weakness are early findings
    • Preservation of light touch is good guide to tissue viability
    • Anesthesia and paralysis = impending gangrene
    • Absence of pulse in pt w/ chronic disease only helpful if accompanied by skin changes
    • Pain with leg elevation
  • Leg claudication

Physical Exam

  • Shiny, hyperpigmented skin, hair loss
  • Ulceration
    • Tend to be on foot/toes, more painful than venous ulcers
  • Cap refill >3sec

Work-Up

  • ABI
    • Ratio of sBP of post tibial or DP to highest brachial pressure in either arm
    • <0.40 = potentially limb-threatening vascular disease
    • 0.41-0.90 = claudication
    • >1.3 = noncompressible vessel (severe vascular calcification)
  • Imaging
    • Ultrasound
      • Accurate for detecting obstruction in femoral/popliteal/bypass grafts
        • Sn declines at/below the calf
    • CTA
      • Sensitivity similar to that of conventional angiography

DDx

  • Phlegmasia cerulea dolens (severe DVT)
  • Phlegmasia alba dolens (severe DVT + arterial spasm)
    • Seen in pregnant women
    • Arterial spasm is transient (do not confuse w/ arterial occlusion)

Treatment

Acute Limb Ischemia

  • Unfractionated Heparin
    • 80 units/kg bolus; then infuse 18units/kg/hr
  • ASA
  • Dependent positioning
  • Pain control
  • Fluid resus / tx of HF as needed to improve limb perfusion

See Also

Source

Tintinalli