Peripheral vascular disease
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Transcript of Peripheral vascular disease
Joel Arudchelvam
Peripheral arteries
Arteries outside of chest and abdomen
Diseases
Occlusive [OAD] Aneurysmal Inflamatory Others
OAD
Causes
Atheromatous Risk Factors
Smoking Diabetes Hypertension Hyperlipidemia Advanced age
InflammatoryTrauma
Presentation
• Claudication
• Rest pain
• Ulcer
• Gangrene
Examination
Vascular - pulse status
Pulse strength
0 - no pulse
1 - faint pulse
2 - diminished than normal
3 - normal
4 - bounding
Examination
Ankle Brachial Pressure index - ankle perssure/ Brachial pressure
Normal – 0.9 to 1.3
Lower limb arteries
Pulse status and possible sites of occlusion
Pulse status and possible sites of occlusion
Aorto iliac
disease
Pulse status and possible sites of occlusion
Fem-pop
disease
Pulse status and possible sites of occlusion
Investigations
General
FBC,SCR,SE,FBS,LIPID PROFILE
To localise and to plan intervention
USS + DOPPLER
CT/MR ANGIOGRAPHY
Management
MedicalGraded exercisesAspirinLipid lowering drugsCilostazolPentoxifyllineFoot careAggressive control of co-morbid diseases
Management
Indications for intervention
1. Disabling claudication
2. Rest pain
3. Tissue loss
ManagementEndovascular
1.angioplasty and/2.stenting
Surgical
1.Bypass2.Endarterctomy
Amputation
Bypass
Conduits
1. Autogenous
saphenous vein
2. Synthetic
PTFE
DACRON(polyester)
Outcome
Major cause of mortality in PVD is cardiac and cerebrovascular disease
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