Difference between revisions of "Peripheral artery disease"

(Diagnosis)
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== Diagnosis ==
 
== Diagnosis ==
 
History
 
History
*6 P's:
+
*6 P's: Pain, pallor, paralysis, pulselessness, paresthesias, polar
**Pain, pallor, paralysis, pulselessness, paresthesias, polar
+
**Paresthesia and weakness are early findings
***Paresthesia and weakness are early findings
+
**Preservation of light touch is good guide to tissue viability
***Preservation of light touch is good guide to tissue viability
+
**Anesthesia and paralysis = impending gangrene
***Anesthesia and paralysis = impending gangrene
+
**Absence of pulse in pt w/ chronic disease only helpful if accompanied by skin changes
***Absence of pulse in pt w/ chronic disease only helpful if accompanied by skin changes
 
 
Physical Exam
 
Physical Exam
 
*Shiny, hyperpigmented skin, hair loss
 
*Shiny, hyperpigmented skin, hair loss

Revision as of 03:44, 1 June 2011

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

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
    • CT (with contrast)
      • Sensitivity similar to that of aortography

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

Source

Tintinalli