Peripheral Arterial Disease

CST teaching

Wissam Al-JundiST3 Vascular Surgery

01/12/2009

PAD Symptoms

• Intermitted Claudication– Distance walked before onset of pain/has to stop– Location

• calf, thigh, buttock

• Ischaemic rest pain:• Severe, unremitting affects toes and MTs• Eased by dependency• Pain experienced on lying flat• Patient usually sleeps in a chair

PAD - Risk factor modification

• To alleviate disability• To prevent major amputation• To reduce the secondary morbidity – Cardiac– Stroke

PAD - Risk factor modification

• Smoking cessation1

• Treatment of Hyperlipidaemia2

• Diabetic control3

• Control of Hypertension4

• Anti-platelet therapy5

• Diet – Fish oils6

• Exercise programmes7

• Others: hyperhomocysteinaemia8

Risk factor modification – smoking cessation

• 70% of POAD patients continue to smoke• Improvement in claudication in 3-6 months• Reduced risk of critical ischaemia• Reduced MI and mortality• 5-10 years future cardiovascular risk

approaches non-smokers

Risk factor modification - hyperlipidaemia

Risk factor modification – anti-platelet therapy

Risk factor modification - Clopidogrel

Risk factor modification: Exercise

Critical limb ischaemia - definition

Angioplasty

Angioplasty + stenting

Indications for intervention

Acute limb ischaemia

Acute limb ischaemia