Periphral Artery Occlusion

Question 1

Risk factors of artery occlusion?

Answer 1

Age / DM / HTN / Hyperlipidemia / smoking

Question 2

What is leriche syndrome?

Answer 2

Traid of :
Claudication
ED
⬇️ distal pulses

Question 3

What is leriche syndrome?

Answer 3

Traid of :
Claudication
ED
⬇️ distal pulses

Question 4

Symptoms and signs?

Answer 4

• symptoms:
  • Intermittent claudication
  • Rest pain
  • Erectile dysfunction
  • Sensorimotor impairment
  • Tissue loss
• Signs:
  • Muscular atrophy
  • Decrease hair growth
  • Thick toenails
  • Tissue necrosis ulcers infection
  • Absent pulses
  • Bruits

Question 5

What hx of pt with PAO?

Answer 5

• Quality (aching, numbness, weakness, fatigue)
• Location (calf, buttock, or thigh)
• Severity of pain and functional limitations
• Typically induced by walking and relieved by rest
• True claudication typically resolves in <10 minutes after stopping activity
• Nocturnal pain and pain at rest are indications of more severe disease
• Risk Factors

Question 6

Sign of occlusion in ( Aortoilliac, Illiac, femoropopliteal, distal obstruction) arteries?

Answer 6

Aortoilliac // Claudication of both buttoks, thighs and calves, femoral and disal pulses absent,bruits, impotence

Illiac// Unilateral claudication of thigh, calf
Unilateral absence of femoral and distal pulses

femoropopliteal // Unilateral claudication in calf , femoral pulse palpable with absent unilateral distal pulses

Distal obstruction// Femoral & popliteal pulses palpable, ankle pulses absent, cluadication in calf & foot

Question 7

How we do ABI ?

Answer 7

Supine position
• Check systolic BP in upper extremities (using Doppler) – use highest value
• Systolic BP in lower extremities – use highest value
• Divide ankle SBP by brachial SBP
• May be falsely elevated in calcified vessels (DM)

Question 8

Value of ABI?

Answer 8

Normal = >0.90
• 0.70 – 0.89 = mild disease
• 0.50 – 0.69 = moderate disease
• <0.50 = severe disease (rest pain/tissue loss)

Question 9

Other Noninvasive Testing for PAO?

Answer 9

• Segmental Pressure Measurements
• Pulse Volume Recordings
• Duplex Scanning
• MRA,CTA
• Contrast angiography

Question 10

Pre-intervention Planning

Answer 10

Ultrasound—duplex scanning
MRA
Angiogram (gold standard; dx and rx in one procedure):invasive

Question 11

Therapeutic Approaches:

Answer 11

Life style modifications:
Reduce risk factors
Exercise ( three times in week for 6 month reach maximum pain)

Medication:
• Vasodilators (not effective)
• Antiplatelet Agents
• Pentoxifylline (Trental)
( An agent which is thought to improve erythrocyte deformability, reduce blood viscosity and decrease platelet reactivty .
AHA recommends use only in cases where exercise therapy has failed or patients are unable to exercise)
• Cilostazol (Pletal)

Surgery:
Percutaneous Translumenal Angioplasty
(• Best for stenosis (rather than occlusion), short segment disease, larger vessels (ie:
iliac), no DM, normal renal function

Bypass Surgery

Embloctomy