Peripheral artery disease resident survival guide

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

• Antiphospholipid antibody
• Atherosclerosis
• Heparin induced thrombocytopenia
• Trauma to artery

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

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.

Treatment

Shown below is the algorithm for the therapeutic approach for peripheral artery disease based on the 2005 and 2011 ACCF/AHA guideline recommendations.

ACE Inhibitors eg Ramipril for treatment of claudication.