Difference between revisions of "Peripheral artery disease"

(DDx)
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***Sensitivity similar to that of conventional angiography
 
***Sensitivity similar to that of conventional angiography
  
== DDx ==
+
==Differential Diagnosis==
 
*[[Phlegmasia Alba Dolens]]
 
*[[Phlegmasia Alba Dolens]]
 
*[[Phlegmasia Cerulea Colens]]
 
*[[Phlegmasia Cerulea Colens]]

Revision as of 22:24, 7 June 2015

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

Differential Diagnosis

Treatment

Acute Limb Ischemia

  • Unfractionated Heparin
    • 80 units/kg bolus; then infuse 18units/kg/hr
  • ASA
  • Dependent positioning
  • Pain control
  • Fluid resuscitation and treatment of heart failure as needed to improve limb perfusion

See Also

Source

Tintinalli