Peripheral aretery disease, previously known as peripheral arterial occlusive disease, one of the most typical presentation is intermittent claudication. As a coronary artery disease risk equivalent, medical therapies should include risk factors modification such as
- Smoking cessation
- Lipid lowering therapy
- Evaluation of HTN and DM.
Diagnosis is generally made through an ABI(ankle-brachial index), which is a resting SBP ratio of ankle/brachial. An ABI =< 0.9 is diagnostic with 90% sensitivity and 95% specificity. Arterial ultrasound may also be conducted but is less sensitive and specific than ABI but it’s advantages are it’s ability to localize the site and determine the severity of the vascular obstruction.
ABI =< 0.9 Abnormal
ABI 0.9 – 1.30 Normal
ABI >= 1.3 Calcified and uncompressible vessel -> consider additional vascular studies
General algorithms for treatment:
- Low dose aspirin(do not consistently reduce claudication symptoms but are indicated to reduce risk of MI, stroke and CV mortality) and statin therapy(high intensity statin therapy – daily atorva 40-80mg/rosuva 20-40mg to reduce CV risk in < 75y/o and atorva 10-20 mg for > 75y/o)
- Supervised exercised program(30-45min three times per week for 12 weeks): goal is to reproduced claudication symptoms (most useful intervention to improve functional capacity and reduce claudication)
- Cilostazol if persistent symptoms despite 1 and 2
- Percutaneous or surgical revascularization if all of the above fails.
Q: 4928, 8928, 4494