Sean Tierney,

Consultant Vascular Surgeon

Adelaide & Meath National Children’s Hospital,

Tallaght

http://www.perfuse.netVascular surgery @ Tallaght

Issues in PAODIssues in PAOD

• Presentation and differential diagnosis

• Assessment/management of cardiovascular risk

• Managing symptoms• Prevention of limb loss

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Presentation & differential diagnosisPresentation & differential diagnosis

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Presentation of atherosclerotic plaquePresentation of atherosclerotic plaque

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Peripheral Arterial Occlusive DiseasePeripheral Arterial Occlusive Disease

• Limitation on exercise (QOL)

• Risk of limb loss

• Global Health risk

Claudicants – concerns?

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PAOD PAOD secondary preventionsecondary prevention

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PAOD – PAOD – predictor of CVS diseasepredictor of CVS disease

Tasc; EJVS; 2000

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PAOD PAOD outcomeoutcome

Tasc; EJVS; 2000

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PAOD PAOD Real risksReal risks

• Limitation on exercise (QOL)

• Risk of limb loss

• Global Health risk

Patients Concerns

• Death from MI/CVA

• Limitation on exercise

• Risk of limb loss

Relative risk

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PAOD Tx PAOD Tx reduce global risk reduce global risk

Measures

• Stop smoking• Optimum therapy underlying disease

(DM, HTN, etc.)• Antiplatelet (? Clopidogrel) CAPRIE

• Statin (? even if normal XOL) ASCOT

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PAOD – PAOD – symptom reliefsymptom relief

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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment

Measures

• Stop smoking

• Exercise

• Drug therapy

• Surgery

approx doubling walking distance

approx doubling walking distance

?

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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment

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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment

Endovascular Open surgery

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PAOD – PAOD – non-critical ischaemianon-critical ischaemia

surgery vs conservative treatment

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PAOD – PAOD – critical ischaemiacritical ischaemia

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PAOD – PAOD – limb salvagelimb salvage

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PAOD – PAOD – limb salvagelimb salvage

Peripheral angioplasty image

0

25

50

75

100

0 12 24 36

10 98

6 54

1No. at risk

Pop distal bypass

Kalbassi et al. IJMS 1999