AR1LRIAL PLRIPHLRAL VASCULAR AR1LRIAL PLRIPHLRAL VASCULAR

DISLASLS DISLASLS
ACU1L AR1LRIAL OCCLUSION : SUDDLN IN1LRRUP1ION ACU1L AR1LRIAL OCCLUSION : SUDDLN IN1LRRUP1ION
OI 1HL BLOOD SUPPPLY RLSUL1 IN A SPLC1RUM OI OI 1HL BLOOD SUPPPLY RLSUL1 IN A SPLC1RUM OI
SYMP1OMS AND SIGNS WHICH ARL DLPLNDLN1 UPON 1HL SYMP1OMS AND SIGNS WHICH ARL DLPLNDLN1 UPON 1HL
LOCA1ION AND LX1LN1 OI 1HL OCCLUSION AND LOCA1ION AND LX1LN1 OI 1HL OCCLUSION AND
LXIS1ING COLLA1LRAL CIRCULA1ION LXIS1ING COLLA1LRAL CIRCULA1ION..
1HL MAJOR CAUSLS ARL : LMBOLISM,1HROMBOSIS,AND INJURY 1HL MAJOR CAUSLS ARL : LMBOLISM,1HROMBOSIS,AND INJURY
IN 1HL ARM,1HL HLAR1 IS 1HL SOURCL OI LMBOLI IN 9S OI 1HL IN 1HL ARM,1HL HLAR1 IS 1HL SOURCL OI LMBOLI IN 9S OI 1HL
PA1ILN1S. PA1ILN1S.
LLSS COMMON CAUSLS INCLUDL LMBOLI IROM ULCLRA1LD PLAQULS IN LLSS COMMON CAUSLS INCLUDL LMBOLI IROM ULCLRA1LD PLAQULS IN
1HL SUB CLAVIAN AR1LRY,ANLURYSM OI 1HL ARCH VLSSLLS AND 1HL SUB CLAVIAN AR1LRY,ANLURYSM OI 1HL ARCH VLSSLLS AND
PARADOXICAL LMBOLI VIA APA1LN1 IORAMLN OVALL. PARADOXICAL LMBOLI VIA APA1LN1 IORAMLN OVALL.
IN 1HL LLG ,1HL HLAR1 IS AGAIN 1HL MOS1 COMMON SOURCL LMBOLI IN 1HL LLG ,1HL HLAR1 IS AGAIN 1HL MOS1 COMMON SOURCL LMBOLI
BU1 1HLY MAY ALSO ARISL IROM ULCLRA1LD PLAQULS AND ANLURYSMS BU1 1HLY MAY ALSO ARISL IROM ULCLRA1LD PLAQULS AND ANLURYSMS
OI 1HL 1HORACIC,ABDOMINAL,ILMORAL,POPLI1LAL AR1LRRILS. OI 1HL 1HORACIC,ABDOMINAL,ILMORAL,POPLI1LAL AR1LRRILS.
OVLR HALI OI 1HL LARGL LMBOLI IROM 1HL HLAR1 LODGL IN 1HL OVLR HALI OI 1HL LARGL LMBOLI IROM 1HL HLAR1 LODGL IN 1HL
ILMORAL AND POPLI1LAL AR1LRILS. ILMORAL AND POPLI1LAL AR1LRILS.
1HL ILIAC AR1LRILS ARL INVOLVLD IN APPROXIMA1LLY ONL 1HL ILIAC AR1LRILS ARL INVOLVLD IN APPROXIMA1LLY ONL- -III1H III1H
1HL ABDOMINAL AOR1A IN ONL 1HL ABDOMINAL AOR1A IN ONL SIX1H SIX1H
AR1LRIAL PLRIPHLRAL VASCULAR AR1LRIAL PLRIPHLRAL VASCULAR
DISLASLS DISLASLS
SOURCL LMBOLI (mural thrombi )
IROM 1HL HLAR1 :
-LLI1 A1RIUM
-LLI1 VLN1RICLL
-AOR1IC VALVL
-MI1RAL VALVL
MURAL 1HROMBI ARISL
SLQONDARY :
- A1RIAL lIBRILA1ION
-M\OCARDIAL INlARC1ION
- AOR1IC AND MI1RAL
PROS1lL1IC VALVL
AR1LRIAL 1HROMBOSIS OCCURS SLQONDARY 1O
INJURY,AR1LRIOSCLLROSIS OBLI1LRANS,ILMORAL AND POPLI1LAL
ANLURYSM,COLLAGLN VASCULAR DISLASLS ,MYLLOPROLIILRA1IVL
DISORDLRS ,DIC,DYSPRO1LINLMIAS.
SYM1OMS AND SIGN SYM1OMS AND SIGN
RLLA1LD 1O 1HL SI1L OI INVOLVLMLN1 AND RLLA1LD 1O 1HL SI1L OI INVOLVLMLN1 AND
IMMLDIA1LLY AVAILABLL COOLA1LRAL CIRCULA1ION IMMLDIA1LLY AVAILABLL COOLA1LRAL CIRCULA1ION
II 1HL PRLSSURL DIS1AL 1O OBS1RUC1ION IALLS 1O II 1HL PRLSSURL DIS1AL 1O OBS1RUC1ION IALLS 1O
BLLOW 40 mmHg, 1HL CLINICAL PIC1URL WILL BL BLLOW 40 mmHg, 1HL CLINICAL PIC1URL WILL BL
DRAMA1IC. DRAMA1IC.
1HL INI1IAL COMPLAIN1 IS PAIN IS 1HL MOS1 DIS1AL 1HL INI1IAL COMPLAIN1 IS PAIN IS 1HL MOS1 DIS1AL
PAR1 OI 1HL LIMB PAR1 OI 1HL LIMB
PALLOR PALLOR
COLDNLSS COLDNLSS
SLNSA1ION OI NUMBNLSS,CU1ANLUS SLNSA1ION IS LOS1 SLNSA1ION OI NUMBNLSS,CU1ANLUS SLNSA1ION IS LOS1
WI1HIN 1HL IIRS1 HOUR WI1HIN 1HL IIRS1 HOUR
WI1HIN 6 HOUR ISCHALMIC MUSCULAR CON1RAC1URL WI1HIN 6 HOUR ISCHALMIC MUSCULAR CON1RAC1URL
DLVLLOPS ASSOCIA1LD WI1H SUB CU1ANLUS DLVLLOPS ASSOCIA1LD WI1H SUB CU1ANLUS
HLMORRHAGL AND IOCAL ARLA OI GANGRLN HLMORRHAGL AND IOCAL ARLA OI GANGRLN
IIXLD S1AINING OI 1HL SKIN IS 1HL MOS1 CLR1AIN SIGN IIXLD S1AINING OI 1HL SKIN IS 1HL MOS1 CLR1AIN SIGN
OI IRRLVLRSIBLL 1ISSUL DLA1H. OI IRRLVLRSIBLL 1ISSUL DLA1H.
DIAGNOSIS DIAGNOSIS
HIS1ORY OI 1HL SUDDLN ONSL1 OI HIS1ORY OI 1HL SUDDLN ONSL1 OI
PAIN,COLDNLS,NUMBNLSS PAIN,COLDNLS,NUMBNLSS
DL1LC1ION OI A BRUI1 IS COMMON WHLN AN AR1LRIAL DL1LC1ION OI A BRUI1 IS COMMON WHLN AN AR1LRIAL
PLAQUL OR ANLURYSM IS 1HL SOURCL OI 1HL LMBOLUS. PLAQUL OR ANLURYSM IS 1HL SOURCL OI 1HL LMBOLUS.
HIS1ORY OI IN1LRMI11LN CLAUDICA1ION HIS1ORY OI IN1LRMI11LN CLAUDICA1ION
ISCHLMIC RLS1 PAIN OI 1HL ILL1 ISCHLMIC RLS1 PAIN OI 1HL ILL1
II 1HL SOURCL OI LMBOLI ORIGINA1L IROM 1HL II 1HL SOURCL OI LMBOLI ORIGINA1L IROM 1HL
1HORASIC AOR1A,ABDOMINAL PAIN AND HLMA1URIA MAY 1HORASIC AOR1A,ABDOMINAL PAIN AND HLMA1URIA MAY
ALSO OCCUR ALSO OCCUR
1HL DIAGNOSIS MAYBL SUSPLC1LD BY PHYSICAL 1HL DIAGNOSIS MAYBL SUSPLC1LD BY PHYSICAL
LXAMINA1ION AND VLRIIILD BY B MODL UL1RA SOUND LXAMINA1ION AND VLRIIILD BY B MODL UL1RA SOUND
AR1LRIOGRAPHY AR1LRIOGRAPHY
1RLA1MLN1 1RLA1MLN1
IMMLDIA1L OPLRA1ION IS RLQUIRLD IOR OCCLUSION OI IMMLDIA1L OPLRA1ION IS RLQUIRLD IOR OCCLUSION OI
1HL MAJOR AR1LRILS. 1HL MAJOR AR1LRILS.
HLPARIN SHOULD BL GIVLN IMMLDIA1LLY HLPARIN SHOULD BL GIVLN IMMLDIA1LLY
1HL OCCLUSION MAY USUALLY BLRLMOVLD UNDLR 1HL OCCLUSION MAY USUALLY BLRLMOVLD UNDLR
LOCAL ANLS1HLSIA,BU1 IN SOML INS1ANCLS I1 MAYBL LOCAL ANLS1HLSIA,BU1 IN SOML INS1ANCLS I1 MAYBL
NLCLSSARY 1O BYPASS 1HL OBS1RUC1LD ARLA. NLCLSSARY 1O BYPASS 1HL OBS1RUC1LD ARLA.
S1RLP1OKINASL OR UROKINASL LOW DOSLS DIRLC1LY S1RLP1OKINASL OR UROKINASL LOW DOSLS DIRLC1LY
IN1O 1HL 1HROMBOSIS VIA AN AR1LRIAL CA1HL1LR IN1O 1HL 1HROMBOSIS VIA AN AR1LRIAL CA1HL1LR
1RANSLUMINAL ANGIOPLAS1Y,OR BY PASS GRAI1ING 1RANSLUMINAL ANGIOPLAS1Y,OR BY PASS GRAI1ING
AI1LR LYSIS OI 1HL 1HROMBUS. AI1LR LYSIS OI 1HL 1HROMBUS.
II 1HL CAUSL OI 1HL PROBLLM IS LMBOLIC LONG1LRM II 1HL CAUSL OI 1HL PROBLLM IS LMBOLIC LONG1LRM
AN1ICOAGULA1ION WI1H WARIARIN OR COUMADIN AN1ICOAGULA1ION WI1H WARIARIN OR COUMADIN
SHOULD BL LMPLOYLD SHOULD BL LMPLOYLD
MICRO LMBOLI SHOULD BL LXPLC1AN1LY WI1H ASPIRIN MICRO LMBOLI SHOULD BL LXPLC1AN1LY WI1H ASPIRIN
AR1LRIOSCLLROSIS OBLI1LRANS AR1LRIOSCLLROSIS OBLI1LRANS
1lL PRIMAR\ LLSION Ol A1LRIOSCLLROSIS 1lL PRIMAR\ LLSION Ol A1LRIOSCLLROSIS
IN 1lL IN1IMAL PALQUL ,\ICl IN 1lL IN1IMAL PALQUL ,\ICl
PROGRLSSIVLL\ NARRO\S AND MAN\ PROGRLSSIVLL\ NARRO\S AND MAN\
INS1ANCLS,LLAD 1O COMPLL1L OCCLUSION INS1ANCLS,LLAD 1O COMPLL1L OCCLUSION
Ol 1lL LARGL AND MLDIUM SIZLD Ol 1lL LARGL AND MLDIUM SIZLD
AR1LRILS. AR1LRILS.
INCIDLNCL : AOR1A ABDOMINAL,ILIAC INCIDLNCL : AOR1A ABDOMINAL,ILIAC
AR1LRILS,POPLI1LAL AR1LRILS ,POS1LRIOR AR1LRILS,POPLI1LAL AR1LRILS ,POS1LRIOR
1IBIAL AR1LRILS,AN1LRIOR 1IBIAL 1IBIAL AR1LRILS,AN1LRIOR 1IBIAL
AR1LRILS, AR1LRILS,
CLINICAL ILA1URLS CLINICAL ILA1URLS
IN1LRMI11LN CLAUDICA1ION : 1HL PAIN 1HA1 OCCURS IN1LRMI11LN CLAUDICA1ION : 1HL PAIN 1HA1 OCCURS
IN A MUSCLL WI1H INADLQUA1L BLOOD SUPPLY 1HA1 IS IN A MUSCLL WI1H INADLQUA1L BLOOD SUPPLY 1HA1 IS
S1RLSSLD BY LXLRCISL. S1RLSSLD BY LXLRCISL.
DISCOMIOR1 AS ACRAMP WI1H DISAPPLARS WI1HIN J OR 2 DISCOMIOR1 AS ACRAMP WI1H DISAPPLARS WI1HIN J OR 2
MIN AI1LR 1HL S1OPING 1HL LXLRCISL MIN AI1LR 1HL S1OPING 1HL LXLRCISL
PARAS1HLSIA PARAS1HLSIA
NUMBNLSS NUMBNLSS
GANGRLNL OI 1HL 1OLS AND DIS1AL IOO1 WHLN 1HL GANGRLNL OI 1HL 1OLS AND DIS1AL IOO1 WHLN 1HL
DISLASLS RLACHLS 1HIS ADVANCLD S1AGL DISLASLS RLACHLS 1HIS ADVANCLD S1AGL
ULCLRS ULCLRS
1ROPHIC NAIL CHANGLS 1ROPHIC NAIL CHANGLS
1HL LOSS OI PULSLS DIS1AL 1O 1HL MOS1 PROXIMAL 1HL LOSS OI PULSLS DIS1AL 1O 1HL MOS1 PROXIMAL
LLVLL OI 1HL DISLASLS LLVLL OI 1HL DISLASLS
BRUI1S BRUI1S
DIAGNOS1IC DIAGNOS1IC
ASSLSSLD SIMPLY BY MLASURING 1HL ANKLL SYS1OLIC ASSLSSLD SIMPLY BY MLASURING 1HL ANKLL SYS1OLIC
BLOOD PRLSURL A1 RLS1 AND IOLLOWING LXLRCISL 1O BLOOD PRLSURL A1 RLS1 AND IOLLOWING LXLRCISL 1O
1HL POIN1 OI CLAUDICA1ION. 1HL POIN1 OI CLAUDICA1ION.
PLL1HYSMOGRAPH PLL1HYSMOGRAPH
UL1RASONIC VLLOCI1Y DL1LC1OR UL1RASONIC VLLOCI1Y DL1LC1OR
IN GLNLRAL,II 1HL SYS1OLIC RLSSURL A1 1HL ANKLL IS IN GLNLRAL,II 1HL SYS1OLIC RLSSURL A1 1HL ANKLL IS
GRLA1LR 1HAN ONL GRLA1LR 1HAN ONL HALI 1HA1 RLCORDLR IROM 1HL HALI 1HA1 RLCORDLR IROM 1HL
ARM,OCCLUSION ONL SLGMLN IS MOS1 LIKLLY. ARM,OCCLUSION ONL SLGMLN IS MOS1 LIKLLY.
ANKLL PRLSSURL LLSS 1HAN ONL HALI OI 1HL ARM ANKLL PRLSSURL LLSS 1HAN ONL HALI OI 1HL ARM
SYS1OLIC PRLSSURL ARL MOS1 OI1LN OBSLRVLD WI1H SYS1OLIC PRLSSURL ARL MOS1 OI1LN OBSLRVLD WI1H
MUL1IPLL LLVLL OI DISLASL. MUL1IPLL LLVLL OI DISLASL.
AR1LRIOGRAPHY AR1LRIOGRAPHY
UL1RASONIC DUPLLX SCANNING UL1RASONIC DUPLLX SCANNING
1HLRAPHY 1HLRAPHY
MILD AND MODLRA1L IN1LRMI1LN1 MILD AND MODLRA1L IN1LRMI1LN1
CLAUDICA1ION MA\ BLNLlI1 lROM A CLAUDICA1ION MA\ BLNLlI1 lROM A
RIGOUS,DAIL\ LXLRCISL 1RAINING RIGOUS,DAIL\ LXLRCISL 1RAINING
PROGRAM PROGRAM
PLN1OX\lILLINL PLN1OX\lILLINL
\LIGl1 RLDUC1ION \LIGl1 RLDUC1ION
S1OP SMOKING S1OP SMOKING
DIRLC1 AR1LRIAL SURGLR\ DIRLC1 AR1LRIAL SURGLR\
1RANSLUMINAL ANGIOPLAS1\ 1RANSLUMINAL ANGIOPLAS1\
1HROMBOANGI1IS OBLI1LRANS ( BULRGLR'S 1HROMBOANGI1IS OBLI1LRANS ( BULRGLR'S
DISLASL ) DISLASL )
NON A1HLROMA1OUS LLSION INVOLVING NON A1HLROMA1OUS LLSION INVOLVING
AR1LRILS,VLIN,NLRVLS AR1LRILS,VLIN,NLRVLS
OCCURING IN YOUNG MALLS AND IRLQULN1LY LLADING OCCURING IN YOUNG MALLS AND IRLQULN1LY LLADING
1O NON HLALING ULCLRS AND GANGRLNL 1O NON HLALING ULCLRS AND GANGRLNL
1HL LXAC1 PA1HOGLNLSIS IS OBSCURL 1HL LXAC1 PA1HOGLNLSIS IS OBSCURL
RLLA1IONSHIP WI1H 1OBACO SMOKING AND CHLWING RLLA1IONSHIP WI1H 1OBACO SMOKING AND CHLWING
ABNORMAL CLLLULLR AND HUMORAL IMMUNL ABNORMAL CLLLULLR AND HUMORAL IMMUNL
RLSPONSLS 1O 1YPL I AND III COLLAGLN RLSPONSLS 1O 1YPL I AND III COLLAGLN
SMALL AR1LRILS OI 1HL HAND AND ILL1 SMALL AR1LRILS OI 1HL HAND AND ILL1
IN1LNSL INILAMMA1ORY COMPONLN1,IIBROUS IN1LNSL INILAMMA1ORY COMPONLN1,IIBROUS
LNCASLMLN1 OI 1HL LN1LRIC NLURO VASCULAR LNCASLMLN1 OI 1HL LN1LRIC NLURO VASCULAR
BUNDLL BUNDLL
Clinical features Clinical features
SUSPLC1 1lL DIAGNOSIS MALL SUSPLC1 1lL DIAGNOSIS MALL
PA1ILN1 20 PA1ILN1 20 -- 40 \LARS AGL 40 \LARS AGL
lIS1OR\ : SUPLRlICIAL MIGRA1OR\ lIS1OR\ : SUPLRlICIAL MIGRA1OR\
PlLLBLLI1IS PlLLBLLI1IS
COLD SLNSI1IVI1\ COLD SLNSI1IVI1\
1RIPlASIC COLOURS RLSPONS 1RIPlASIC COLOURS RLSPONS
INS1LP CLAUDICA1ION INS1LP CLAUDICA1ION