Peripheral artery disease resident survival guide: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===General Approach=== | ===General Approach=== | ||
<span style="font-size:85%">'''Abbreviations:''' '''ABI:''' [[Ankle brachial index]]; '''PAD:''' [[Peripheral artery disease]]; '''TBI:''' [[Toe-Brachial Index]]</span> | |||
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{{familytree | | D01 | | | | | D02 | | | | | | | | D03 | |D01= '''≤ 0.90'''|D02= Normal <br> '''0.91-1.30'''|D03= '''> 1.30'''}} | {{familytree | | D01 | | | | | D02 | | | | | | | | D03 | |D01= '''≤ 0.90'''|D02= Normal <br> '''0.91-1.30'''|D03= '''> 1.30'''}} | ||
{{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}} | {{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}} | ||
{{familytree | | |!| | | | | | E01 | | | | | | | | E02 | |E01= Order Exercise ABI|E02= Order [[Toe-Brachial Index]] <br> OR <br> Pulse volume recording <br> OR <br> [[Duplex ultrasound | {{familytree | | |!| | | | | | E01 | | | | | | | | E02 | |E01= Order Exercise ABI|E02= Order [[Toe-Brachial Index]] <br> OR <br> Pulse volume recording <br> OR <br> [[Duplex ultrasound]]}} | ||
{{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}} | {{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}} | ||
{{familytree | | |!| | | | | | F01 | | | | | | | | F02 |F01=Does the patient have > 20% decrease in Postexercise ABI?|F02= Is TBI < 0.7?}} | {{familytree | | |!| | | | | | F01 | | | | | | | | F02 |F01=Does the patient have > 20% decrease in Postexercise ABI?|F02= Is TBI < 0.7?}} | ||
Revision as of 18:57, 29 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
Peripheral artery disease (PAD) is a circulatory disorder due to narrowing of the arteries of the limbs which lead to a reduction in blood flow to the lower extremities. It is most commonly caused by atherosclerosis and generally used to refer to the atherosclerotic peripheral arterial lesions in the lower extremities. PAD manifests commonly as leg pain at rest or exertion and it can be treated successfully with lifestyle modification and reduction of risk factors such as smoking cessation, control of diabetes and hypertension e.t.c. Complications do arise in PAD such as the development of leg ulcers and gangrenous limbs that would occasionally lead to amputation.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
Boxes in salmon color signify that an urgent management is needed.
Diagnosis
General Approach
Abbreviations: ABI: Ankle brachial index; PAD: Peripheral artery disease; TBI: Toe-Brachial Index
| Suspected PAD | |||||||||||||||||||||||||||||||||||||||||||||||||
Symptoms: ❑ Leg pain at rest ❑ Reduced or absent pulses ❑ Leg pain during exertion ❑ Gangrene ❑ Pale extremity ❑ Non healing wound ❑ Calf or foot cramping ❑ Paresthesias | |||||||||||||||||||||||||||||||||||||||||||||||||
| Order Ankle brachial index | |||||||||||||||||||||||||||||||||||||||||||||||||
| ≤ 0.90 | Normal 0.91-1.30 | > 1.30 | |||||||||||||||||||||||||||||||||||||||||||||||
| Order Exercise ABI | Order Toe-Brachial Index OR Pulse volume recording OR Duplex ultrasound | ||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient have > 20% decrease in Postexercise ABI? | Is TBI < 0.7? | ||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||
| PAD confirmed | No PAD | PAD confirmed | |||||||||||||||||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention. The algorithm below is based on the 2005 and 2011 ACCF/AHA guidelines.[1]
Treatment
Shown below is the algorithm for the therapeutic approach for peripheral artery disease based on the 2005 and 2011 ACCF/AHA guideline recommendations.[1]
ACE Inhibitors eg Ramipril for treatment of claudication.[2]
Asymptomatic
Claudication
Critical Limb Ischemia
Medications
Do's
Don'ts
References
- ↑ 1.0 1.1 Anderson, Jeffrey L.; Halperin, Jonathan L.; Albert, Nancy; Bozkurt, Biykem; Brindis, Ralph G.; Curtis, Lesley H.; DeMets, David; Guyton, Robert A.; Hochman, Judith S.; Kovacs, Richard J.; Ohman, E. Magnus; Pressler, Susan J.; Sellke, Frank W.; Shen, Win-Kuang (2013). "Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations)". Journal of the American College of Cardiology. 61 (14): 1555–1570. doi:10.1016/j.jacc.2013.01.004. ISSN 0735-1097.
- ↑ Ahimastos, Anna A.; Walker, Philip J.; Askew, Christopher; Leicht, Anthony; Pappas, Elise; Blombery, Peter; Reid, Christopher M.; Golledge, Jonathan; Kingwell, Bronwyn A. (2013). "Effect of Ramipril on Walking Times and Quality of Life Among Patients With Peripheral Artery Disease and Intermittent Claudication". JAMA. 309 (5): 453. doi:10.1001/jama.2012.216237. ISSN 0098-7484.