1. PERIPHERAL VASCULAR DISEASE Valerie Robinson D.O.

2. Peripheral Vascular Disease AKA Peripheral Artery Disease AKA Arteriosclerosis Obliterans Caused by atherosclerosis Arterial walls lose compliance Is usually progressive May occlude medium and large arteries Vascular disease may manifest acutely when thrombi, emboli, or acute trauma compromises perfusion. Risk factors Dyslipidemia Diabetes CAD HTN Renal failure Smoking Hx of CVA or MI

3. Symptoms Most commonly found in the lower extremities Claudication – worse when walking fast, uphill, or for a long distance Aortoiliac disease manifests as pain in the thigh and buttock, whereas femoral-popliteal disease manifests as pain in the calf Slow healing Poor circulation (pale, cool feet) Raynaud’s phenomenon Ulcers and/or Gangrene Neuropathy Night-time leg cramps Pain gets better when leg is hanging Leriche syndrome is a clinical syndrome described by intermittent claudication, impotence, and significantly decreased or absent femoral pulses.

4. Diagnosis: Physical Exam Peripheral signs of peripheral vascular disease are the classic "5 P's": Pulselessness Paralysis Paraesthesia Pain Pallor Ankle-brachial index Bruits Loss of hair on legs and feet, skin becomes pale and shiny Atrophied muscles, especially calf Ulcers Cyanosis/paleness

5. Diagnosis: Tests Ankle-Brachial Index (ABI) BPankle/BPbiceps If <0.9, mild PAD. Between 0.5 and 0.9 is moderate dz with claudication If <0.5, severe PAD often has gangrene or ulcers Doppler Angiography, MRA, or CTA

7. Before and after stent

8. Treatment Increase exercise, but allow time for rest Control risk factors such as smoking, HTN, lipids, DM Anti-platelet drugs: aspirin, Plavix (clopidogrel) Phosphodiesterase inhibitors: Trental (pentoxifylline), Pletal (cilostazol) Statins Amputation, ABI<0.3 Angioplasty with stents Bypass

9. References “Peripheral artery disease – legs.” A.D.A.M. Medical Encyclopedia. PubMed Health. U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/. Updated May 14, 2012 “Doppler assessment and ABPI: Interpretation in the management of leg ulceration.” World Wide Wounds. http://www.worldwidewounds.com/2001/march/Vowden/D oppler-assessment-and-ABPI.html Stephens, Everett MD. “Peripheral Vascular Disease.” Medscape. http://emedicine.medscape.com/article/761556- overview#showall Updated March 15 2010.