peripheral arterial disease : pad
DESCRIPTION
Peripheral Arterial Disease : PAD. นพ.ธีรพล เกาะเทียน นายแพทย์ชำนาญการพิเศษ. ศัลยแพทย์โรคหัวใจ หลอดเลือด และทรวงอก โรงพยาบาลสรรพสิทธิประสงค์ อุบลราชธานี. Introduction. PAD caused by atherosclerotic occlusion of arteries to legs - PowerPoint PPT PresentationTRANSCRIPT
Peripheral Arterial Disease :PAD
นพ. ธรพล เกาะเทยนนายแพทยชำานาญการพเศษ
ศลยแพทยโรคหวใจ หลอดเลอด และทรวงอก โรงพยาบาลสรรพสทธประสงค อบลราชธาน
Introduction
PAD caused by atherosclerotic occlusion of arteries to legs Prevalence 12% and increases to 20% if persons older than 70 yr. Affects men and women equally pt. with PAD , even absence of Hx of MI or ischemic stroke have same relative risk of death from CVS cause as pt. with Hx of CAD or CVD
Introduction
Rate of death of all causes equal in men and women and is elevated even in asymptomatic pt. Severity of PAD is closely associated with risk of MI , ischemic stroke , and death from vascular cause Lower ABI – greater risk of CVS events Critical leg ischemia – mortality of 25%
RISK FACTOR
Smoking DM HT Hypercholesterolemia
Normal Artery and Artery With Plaque Buildup
PAD in THAILAND
Male 4% Female 8%
Risk Factor Age DM > 12 yrs HT
A Life Threatening Condition
The REACH (Reduction of Atherothrombosis for Continued Health) Registry has expanded mortality associated with PAD
At one year, 19% of the PAD population had experienced either an MI, a stroke or were hospitalised for an atherothrombotic event or had died from CV causes compared to 10% of the CAD population and 7% of CVD population.
PAD vs DM
DM ทำ�ใหเพมคว�มชกของ PAD 2เท�
1.5% ของผปวย DM จะถกตดนว ข�
50% จะถกตดเพม 50% ถกตดอกข�ง ภ�ยใน 2 ป 50% ทถกตดข� เสยชวต ภ�ยใน
5 ป
Clinical Staging of LEAD
Screening for PAD
ABI
Selection of patient high risk
DM
Age 50 years.
Ankle-Brachial Index (ABI)
INTERPRETATION
NORMAL 0.9 -1.30
MILD 0.7-0.89
MODERATE 0.4-0.69
SEVERE < 0.4 POORLY COMPRESSIBLE > 1.3
TREATMENT
งดสบบหร ออกกำาลงกาย ควบคม ความดน (140/90 mmHg) LDH < 100 Medication Endovascular treatment Surgery
ก�รประเมนผปวยทมอ�ก�ร Claudication
ผปวยทมอาการแบบ classic claudication
ตรวจรางกายระบบหลอดเลอด
ตรวจ resting ankle - brachial index (resting ABI)
ABI ≤ 0.90 ABI > 0.90
- Exercise ABI - Toe-brachial index - Segmental pressure measurement - Duplex ultrasound exam.
Confirmation of
PAD diagnosis
Abnormal results
Normal results
No PAD or consider arterial entrapment syndrome
- Risk factors normalization - Pharmacological risk
การรกษาภาวะclaudication
Intervention of PAD
Toe gangrene in a patient with diabetes
AORTO-ILIAC LESIONS
Lesion type
Type A
Type B
Description
* Unilateral or bilateral stenosis of CIA
* Unilateral or bilateral single short (≤3cm) stenosis
of EIA
* Short (≤3cm) stenosis of infrarenal aorta* Unilateral CIA Occlusion
* Single or multiple stenosis totaling 3-10cm. Involving the EIA occlusion not involving the origins of internal iliac of
CFA
AORTO-ILIAC LESIONS
Lesion type
Type C
Type D
Description* Bilateral CIA occlusion
* Bilateral EIA stenosis 3-10cm long not extending into the CFA
* Unilateral EIA stenosis extending tnto the CFA* Unilateral EIA occlusion that involves the
origins of internal iliac and/or CFA* Heavily calcified unilateral EIA occlusion with
or without involvement of origins of internal iliac and/or CFA
* Infra-renal aorto-iliac occlusion* Diffuse disease involving the aorta and both iliac arteries
requiring treatment* Diffuse multiple stenosis involving the unilateral CIA, EIA
and CFA* Unilateral occlusions of both CIA and EIA
* Bilateral occlusion of EIA* Iliac stenosis in patients with AAA requiring treatment and
not amenable to endograft placement or other laesions requiring open aortic or iliac surgery
FEMORAL-POPLITEAL LESIONS
Lesion type
Type A
Type B
Description
* Single stenosis ≤10cm in length
* Single occlusion ≤5cm in length
* Multiple lesions (stenoses or occlusion),each ≤5cm
* Single stenosis or occlusion ≤15cm not involving the infra geniculate popliteal artery
* Single or multiple lesions in the absence of continuous tibial vessels to improve inflow for a distal bypass
* Heavily calcified occlusion ≤5cm inlength* Single popliteal stenosis
FEMORAL-POPLITEAL LESIONS
Lesion type
Type C
Type D
Description
* Multiple stenoses or occlusions totaling >15cm with or without
heavy calcifications* Recurrent stenoses or occlusion
that need treatment after two endovascular interventions
* Chronic total occlusion of CFA of SFA (>20cm, involving
the popliteal artery)* Chronic total occlusion of popliteal
artery and proximal trifurcation vessels
THANK YOU
Question ?