Peripheral artery disease: Difference between revisions
Line 29: | Line 29: | ||
***Accurate for detecting obstruction in femoral/popliteal/bypass grafts | ***Accurate for detecting obstruction in femoral/popliteal/bypass grafts | ||
****Sn declines at/below the calf | ****Sn declines at/below the calf | ||
** | **CTA | ||
***Sensitivity similar to that of | ***Sensitivity similar to that of conventional angiography | ||
== DDx == | == DDx == |
Revision as of 20:06, 20 July 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
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- CTA
- Sensitivity similar to that of conventional angiography
- Ultrasound
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