peripheral vascular disease

Joel Arudchelvam

Peripheral arteries

Arteries outside of chest and abdomen

Diseases

Occlusive [OAD] Aneurysmal Inflamatory Others

OAD

Causes

Atheromatous Risk Factors

Smoking Diabetes Hypertension Hyperlipidemia Advanced age

InflammatoryTrauma

Presentation

• Claudication

• Rest pain

• Ulcer

• Gangrene

Examination

Vascular - pulse status

Pulse strength

0 - no pulse

1 - faint pulse

2 - diminished than normal

3 - normal

4 - bounding

Examination

Ankle Brachial Pressure index - ankle perssure/ Brachial pressure

Normal – 0.9 to 1.3

Lower limb arteries

Pulse status and possible sites of occlusion

Pulse status and possible sites of occlusion

Aorto iliac

disease

Pulse status and possible sites of occlusion

Fem-pop

disease

Pulse status and possible sites of occlusion

Investigations

General

FBC,SCR,SE,FBS,LIPID PROFILE

To localise and to plan intervention

USS + DOPPLER

CT/MR ANGIOGRAPHY

Management

MedicalGraded exercisesAspirinLipid lowering drugsCilostazolPentoxifyllineFoot careAggressive control of co-morbid diseases

Management

Indications for intervention

1. Disabling claudication

2. Rest pain

3. Tissue loss

ManagementEndovascular

1.angioplasty and/2.stenting

Surgical

1.Bypass2.Endarterctomy

Amputation

Bypass

Conduits

1. Autogenous

saphenous vein

2. Synthetic

PTFE

DACRON(polyester)

Outcome

Major cause of mortality in PVD is cardiac and cerebrovascular disease

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