Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Cramping Leg Management of peripheral vascular disease

Similar presentations

Presentation on theme: "The Cramping Leg Management of peripheral vascular disease"— Presentation transcript:

1 The Cramping Leg Management of peripheral vascular disease
Dr Patricia Yih Department of Surgery, Pamela Youde Nethersole Eastern Hospital Joint Hospital Surgical Grand Round 04/2009

2 Epidemiology General prevalance 3-10% (ABI < 0.9)
>70 years old: 15-20% Asymptomatic 75% Symptomatic: Intermittent claudication Critical limb ishcemia

3 Clinical Course Hirsch AT et al. J Am Coll Cardiol

4 Asymptomatic PVD Vascular disease progression related to baseline ABI Identical to symptomatic patients Coexisting vascular disease (atherosclerotic) Coronary artery disease CVA Risk: MI/CVA 5-7%/year, mortality 2%/year Also related to baseline ABI Management: Intensive risk factor modifiation Antithrombotic therapy Mehler PS et al. Circulation 2003

5 Intermittent Claudication
Only about 25% deteriorate ever Disease progression related to: ABI (<0.50  >2x more likely need intervention/amputation) Low ankle pressure (40-60mmHg  8.5% limb loss/year) At 5 years: Hirsch AT et al. J Am Coll Cardiol 2006; 47:

6 Risk Factor Modification
Stop smoking Control of BP Control of DM Control of hyperlipidemia Weight reduction

7 Exercise Rehabilitation
Supervised Program: Treadmill or track walking to bring on claudication Followed by rest until pain subsided Then resume 30-60 minute sessions 3 times/week, for 3 months (TASC II guidelines, Recommendation 14) Selective exercise of most ischemic muscles Doubles claudication distance in 80% of patients Stewart K et al. N Engl J Med 2002

8 Drugs Antiplatelet agents Cilostazol (PletaalTM)
Aspirin Clopidogrel Cilostazol (PletaalTM) Vasodilator, metabolic and antiplatelet activity Increased walking distance 50-70m Best evidence Naftidrofuryl (PraxileneTM) Improve muscle metabolism, reduce RBC/platelet aggregation Increased walking distance by 26% Pentoxifylline Similar to placebo Regensteiner J et al. J Am Geriatr Soc 2002 Lehert P et al. J Cardiovasc Pharmacol 1994

9 Indications for Intervention
Severe, lifestyle-limiting claudication Failed drug therapy and exercise Prerequisite: Inflow satisfactory Distal runoff patent

10 “Stupid Femoral Artery” High failure rate after intervention
SFA Disease “Stupid Femoral Artery” High failure rate after intervention

11 Factors affecting result of intervention
Multiple lesions Long segment stenosis Complete occlusion Below knee

12 Choice of intervention
Surgical bypass Vein graft Prosthetic graft Endovascular Angioplasty Primary stenting Arthrectomy

13 Outcome Measures Usually considered together with critical ischemia
Patency rate ABI Limb salvage Mortality

14 Surgical Bypass vs Angioplasty
If high risk for surgery Bypass TASC classification

15 Surgical Bypass – Conduit
Autogenous vs prosthetic materials: De Vries S et al, J Vasc Surg 1997 In-situ vs reversed vein graft: No difference Mamode N et al, Cochrane Database Syst Rev. 2000

16 Angioplasty vs Stenting
Meta-analysis: no difference 1-Year Patency Rate Postoperative ABI Mwipatayi et al, Journal of Vascular Surgery, Feb 2008

17 Conclusion Clinical course/deterioration, systemic disease related to baseline ABI When to intervene? Lifestyle limiting claudication, failure of conservative management Radiological confirmation of adequate inflow and runoff required Bypass or angioplasty? Depends on disease location, extent Angioplasty: to stent or not? No difference Depends on expertise available, patient condition

18 Thank you!

Download ppt "The Cramping Leg Management of peripheral vascular disease"

Similar presentations

Ads by Google