Departemen Bedah RSMH/FK Unsri

Pendidikan Dokter Spesialis-1 Ilmu Bedah

Peripheral Arterial Occlusive Disease

dr. Riki Saputra

 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

• Peripheral arterial disease (PAD)

• Circulatory problem causing a reduced blood flow

through the arteries. (Poor circulation/ Decreased
perfusion)

• Peripheral vascular disease (PVD)  more general

Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Lower Extrimity symptoms

Classified into two large categories:
• Acute limb ischemia (ALI) 
thrombotic, embolic, acute excacerbation of atherosclerotic
• Chronic limb ischemia (CLI)(> 2weeks)
atherosclerosis plaque build up

Reference:
Brunicardi. F. C (2019). Schwart’s Principles of Surgery.11th ed. New York: Mc Graw Hill. 2019
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Figure 1. Figure 2.
Non-healing necrotic ulceration and gangrene of High Grade Stenosis of Dorsalis Pedis Artery of the
the 3rd digit secondary to PAD foot.
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Etiology
• Atherosclerosis
• Thromboemboli
• Inflammation
• Injury
• Radiation Exposure

Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Risk Factors
• Diabetes
• Smoking
• Obesity
• Hypertension
• Dyslipidemia
• Age >50 y.o
• Family history
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Epidemiology
• 200 million adults worldwide
• 20% in people over the age of 70
• Smoking  4 folds risk of critical limb ischemia

Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Patophysiology
• Complex interactions
between cholesterol and
vascular endhotelium
• Plaque build up
• Narrowing vessel
• Supply demand mismatch
Figure 3.
• ischemia PAD
source my.Clevelandclinic.org
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

History and Physical

Intermittent Claudication
thigh or calf pain during walking or exertion, relieved
by rest
Asymptomatic  Limb threatening
Physical exam
• 5P (pain, pulseless, pallor, paresthesia, paralysis)
• Presence of bruit
• Poikiloterima -->Cold to touch
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

History and Physical

Reference:
Brunicardi. F. C (2019). Schwart’s Principles of Surgery.11th ed. New York: Mc Graw Hill. 2019
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Classification

Reference:
Brunicardi. F. C (2019). Schwart’s Principles of Surgery.11th ed. New York: Mc Graw Hill. 2019
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Evaluation
(ABI) ankle-brachial index
•  systolic blood pressure at the ankle to the systolic
pressure in the arm (Normal 0.9-1.3)
Doppler, CT-A, MR-A, Contrast-A (Gold Standard)
• Determine sites of the occlusion
Transcutaneous Oxymetri
• Rapid assessment of perfusion
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Differential Diagnosis
• Deep vein thrombosis
• Thrombophelbitis
• Raynaud phenomenon
• Thromboangiitis obliterans/ Burger’s Disease
• Sciatica

Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Treatment
Life style change
Quitting smoking, lowering cholesterol, and
controlling hypertension and diabetes
Medication
• Ciloztazol
• Aspirin
• Statins
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Treatment
Life style change
Quitting smoking, lowering cholesterol, and
controlling hypertension and diabetes
Medication
• Ciloztazol
• Aspirin
• Statins
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Treatment
Minimal invasive
Balloon angioplasty

 Surgical
• Bypass grafts divert flow around the blockage
• Endarterectomy  segmentally remove the
obstructive plaque
Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Outcome
• Coexisting cerebrovascular incidence
• Outcomes in woman tend to be worst

Reference:
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Thank you
 Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah

Reference
1.) Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial
Disease. [Updated 2022 Jan 9]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
2.) Brunicardi. F. C (2019). Schwart’s Principles of
Surgery.11th ed. New York: Mc Graw Hill. 2019