Peripheral artery disease: Difference between revisions
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***Sensitivity similar to that of conventional angiography | ***Sensitivity similar to that of conventional angiography | ||
== | ==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
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- CTA
- Sensitivity similar to that of conventional angiography
- Ultrasound
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