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Peripheral Artery Diseases

Aldo Ferly

Supervisor:
dr. Taofan Siddiq, Sp.JP(K)
Peripheral Artery Disease
Presence of flow-limiting lesion in artery that
provides blood supply to the limbs.

It Is very important to learn peripheral artery


disease….

European Society of Cardiology. Gudelines on the Diagnosis and


Treatment of Peripheral Artery Disease. 2011. Accessed 2013 Jan
15
Implications
• Same risk factors w/ atherosclerosis
Implications
• Almost 20% has coronary artery diseases

Underdiagnosis

Source: T Mirsch, MH Criqui, D Treat-Jacobson. Peripheral Arterial


Diseases Detection, Awareness and Treatment in Primary Care.
JAMA. 2001
Awareness still low

49%

Source: T Mirsch, MH Criqui, D Treat-Jacobson. Peripheral Arterial


Diseases Detection, Awareness and Treatment in Primary Care.
JAMA. 2001
What causes PAD?
Peripheral
Atherosclerosis Atherosclerotic
Vascular Disease

Mechanic cause Thromboembolism

Inflammation Vasculitis
Peripheral Atherosclerotic Vascular
Disease : Clinical Presentations
• Claudication
– Buttocks, thight, calf discomfort prescipitated by
walking and relived by rest
Clinical Presentation

Watch out for secondary bacteria infection!


What to do as primary care physician?
• Calculate Angkle-Brachial Index
– Measure BP in ankles (left right) and arms(left
right)
– Get the systolic value
– Divide the ankle pressure with arm pressure
Interpretation
• Normal : ABI>=1.0
• <0.9  diagnostic PAD, claudication
symptoms
• <0.5  severe pain at rest
Treatment
Prevention of cardiovascular events
• Non-medical treatment
– Risk factor modification
• Medical treatment
– Antiplatelet therapy : aspirin
Treatment
For the foot itself
• Non-medical treatment
– Exercise program
Exercise Regiment

Source: Hamburg N, Balady G. Exercise Rehabilitation in Peripheral


Artery Disease: Functional Impact and Mechanism of Benefits.
Circulation. 2011; 123: 87-97
ACUTE ARTERIAL OCCLUSION
Acute Arterial Occlusion
Embolization materials from cardiac/non-cardiac
origin in distal artery
Origins of Emboli
• Cardiac origin
– Stagnant left atrial flow
– Left ventricle mural thrombus
– Valvular lesions
– Left atrial myxoma
• Aortic origin
– Thrombus from atherosclerotic segment
• Venous origin
Diagnosis
• 6 P:
– Pain
– pallor
– paralysis
– parasthesia
– pulselessness
– poikilothermia
VASCULITIS SYNDROME
Definition
• Immune depsoition on the vessel wall
Diseases
• Takayatsu arteritis
• Giant cell arteritis
• Buerger Disease
Takayatsu Disease
• 1.2 in 1.000.000 people
• 90% in women
• Affect Aorta
• Signs : Puselessnes
• Treatment: Steroid and cytotoxic drug
Giant Cell arteritis
• Affect medium to large blood vessels
Epidemiology
• 24 in 100,000 people
• After age 50
• 65% female
Signs and Symptoms
• Depends on the location
– Temporal artery : prominent headache
– Facial artery: facial pain, jaw pain when chewing
– Opthalmic artery: impaired vision (blidness in
20%)
Diagnosis
• Ultrasound
• Biopsy
Treatment
• Self limiting
• High-dose steroid
Buerger Disease
• Distal vessels on upper/lower extremities
Epidemiology
• Men <45 years old
• Cigarette smoking is a huge risk factor
Signs/Symptoms
• Distal arterial occlusion
• Raynaud phenomenon
• Migrating superficial vein thrombophlebitis

Source: Lilly, LS. Lily’s Patophysiology of Heart Disease. 5th Edition. Wolters
Kluwer Health: Philadelphia. P. 346-349
Treatment
• Smoking cessation
• Debridement of necrotic tissue
Reference
1.T Mirsch, MH Criqui, D Treat-Jacobson.
Peripheral Arterial Diseases Detection,
Awareness and Treatment in Primary Care.
JAMA. 2001
2.Hamburg N, Balady G. Exercise Rehabilitation
in Peripheral Artery Disease: Functional Impact
and Mechanism of Benefits. Circulation. 2011;
123: 87-97
3.Lilly, LS. Lily’s Patophysiology of Heart Disease.
5th Edition. Wolters Kluwer Health: Philadelphia.
P. 346-349