Peripheral artery disease: Difference between revisions
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== Background == | ''See [[acute arterial ischemia]] for acute limb ischemia'' | ||
==Background== | |||
*Peripheral artery disease = ABI <0.9 (normal ≥1.0)<ref>Heald CL, et al. Ankle Brachial Index C. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189:61–69.</ref> | *Peripheral artery disease = ABI <0.9 (normal ≥1.0)<ref>Heald CL, et al. Ankle Brachial Index C. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189:61–69.</ref> | ||
*>70% of | *>70% of patients are either former or current smokers<ref>Ng EL, et al. Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department. Vascular. 2014; 22(1):1-12.</ref> | ||
*33% of deaths are from reperfusion injury | *33% of deaths are from reperfusion injury | ||
**Myoglobinemia, ARF, | **Myoglobinemia, ARF, increased CK | ||
*Thrombosis accounts for >80% of lower limb ischemia | *Thrombosis accounts for >80% of lower limb ischemia | ||
*PAD indicates systemic atherosclerosis<ref>Levy PJ. Epidemiology and pathophysiology of peripheral arterial disease. Clin Cornerstone. 2002;4:1–15.</ref> | *PAD indicates systemic atherosclerosis<ref>Levy PJ. Epidemiology and pathophysiology of peripheral arterial disease. Clin Cornerstone. 2002;4:1–15.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:NecrosisDuetoPAD.jpg|thumb|Peripheral arterial disease resulting in necrosis of multiple toes]] | |||
*Shiny, hyperpigmented skin, hair loss | *Shiny, hyperpigmented skin, hair loss | ||
*Ulceration | *Ulceration | ||
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*[[Venous thromboembolism]] | *[[Venous thromboembolism]] | ||
{{Foot diagnoses}} | |||
== | |||
==Evaluation== | |||
===ABI=== | |||
*Measuring | *Measuring | ||
*#Position patient supine | *#Position patient supine | ||
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**<0.40: severe occlusion | **<0.40: severe occlusion | ||
**>1.30: poorly compressible/calcified vessels | **>1.30: poorly compressible/calcified vessels | ||
===Imaging=== | |||
*Xray | *Xray | ||
**Little use or benefit | **Little use or benefit | ||
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**Detailed images of vasculature can be taken and plaques identified | **Detailed images of vasculature can be taken and plaques identified | ||
=== | ==Management== | ||
*Chronic PAD can recieve outpatient management (by vascular) | |||
* | |||
==Disposition== | ==Disposition== | ||
*Chronic PAD can be managed as an outpatient | *Chronic PAD can be managed as an outpatient | ||
==See Also== | ==See Also== | ||
*[[Foot Diagnoses]] | *[[Foot Diagnoses]] | ||
*[[Vascular injury]] | |||
==External Links== | ==External Links== | ||
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<references/> | <references/> | ||
[[Category:Vascular]] | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Surgery]] | ||
Revision as of 07:05, 6 March 2019
See acute arterial ischemia for acute limb ischemia
Background
- Peripheral artery disease = ABI <0.9 (normal ≥1.0)[1]
- >70% of patients are either former or current smokers[2]
- 33% of deaths are from reperfusion injury
- Myoglobinemia, ARF, increased CK
- Thrombosis accounts for >80% of lower limb ischemia
- PAD indicates systemic atherosclerosis[3]
Clinical Features
- Shiny, hyperpigmented skin, hair loss
- Ulceration
- Tend to be on foot/toes, more painful than venous ulcers
- Cap refill >3sec
Differential Diagnosis
Foot diagnoses
Acute
- Foot and toe fractures
- Subtalar dislocation
- Metatarsophalangeal joint sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Paronychia
- Tinea pedis
- Morton's neuroma
- Diabetic neuropathy
Evaluation
ABI
- Measuring
- Position patient supine
- Measure SBP from both brachial arteries using cuff and handheld Doppler over the AC fossa
- Measure SBP from both DP and PT arteries using cuff placed just proximal to the malleoli with Doppler over artery (5-8% of normal patients have absent DP pulse)
- Calculate ABI on each leg by taking the highest ankle SBP divided by the highest brachial SBP and record to 2 decimal places
- Using calculation
- 0.91–1.30: normal
- 0.70–0.90: mild occlusion
- 0.40–0.69: moderate occlusion
- <0.40: severe occlusion
- >1.30: poorly compressible/calcified vessels
Imaging
- Xray
- Little use or benefit
- Ultrasound
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- Sn declines at/below the calf
- Quality of signal (triphasic, biphasic, monophasic) is important to note
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- CTA
- Sensitivity similar to that of conventional angiography
- MRI
- Limited utility in the ED setting
- Detailed images of vasculature can be taken and plaques identified
Management
- Chronic PAD can recieve outpatient management (by vascular)
Disposition
- Chronic PAD can be managed as an outpatient
See Also
External Links
References
- ↑ Heald CL, et al. Ankle Brachial Index C. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189:61–69.
- ↑ Ng EL, et al. Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department. Vascular. 2014; 22(1):1-12.
- ↑ Levy PJ. Epidemiology and pathophysiology of peripheral arterial disease. Clin Cornerstone. 2002;4:1–15.