Peripheral Artery Disease

What is the definition of PAD?

Flow‑limiting atherosclerotic disease of lower‑extremity arteries causing asymptomatic, lifestyle‑limiting, or limb‑threatening ischemia.

Major systemic associations of PAD?

Strongly associated with CAD, cerebrovascular disease, and increased all‑cause mortality.

Diagnostic of PAD?

Ankle/Brachial Index (ABI) ≤0.90 defines PAD

Most important risk factors for PAD?

Diabetes and smoking (highest odds ratios).

Clinical manifestations of PAD?

Asymptomatic, claudication(exertion related muscular pain releived by rest), critical limb ischemia (rest pain, ulcers, gangrene).

Definition of claudication?

Exertion‑related muscle pain relieved by rest due to ischemia.

Major predictors of progression of PAD to Critical Limb Ischemia?

ABI is low(<0.7), diabetes, continued smoking

Natural history of critical limb ischemia?

40% limb loss at 6 months, 20% mortality at 6 months

Physical exam clues for PAD?

Absent pulses, cool feet, dependent rubor, delayed cap refill, hair loss, thick nails, foot/toe ulcers.

Indications to obtain ABI?

Exertional leg symptoms, non‑healing wounds, age >65, age >50 with smoking or diabetes.

ABI interpretation?

Normal ≥0.90

First‑line PAD management?

Risk‑factor modification: smoking cessation, statins, diabetes control, BP control, antiplatelet therapy, exercise.

Benefits of smoking cessation in PAD?

Reduces amputation, revascularization, graft failure

Antiplatelet therapy recommendations in PAD?

Aspirin 75–325 mg daily OR clopidogrel 75 mg daily

Pharmacologic therapy for claudication?

Cilostazol (PDE‑III inhibitor) improves walking distance

Revascularization outcomes for claudication?

Supervised exercise often equals or exceeds angioplasty/stenting for walking distance improvement.

Factors predicting poor functional outcomes after Critical Limb Ischemia (CLI) surgery?

CKD, impaired ambulation, diabetes, prior revascularization.

Best conduit for bypass?

Great saphenous vein.

Most common source of arterial emboli?

Heart (atrial fibrillation, LV thrombus, MI, aneurysm, myxoma, vegetations).

Features of arterial embolism?

Abrupt onset, profound ischemia, no collaterals, intact contralateral pulses.

Atheroembolism (“blue toe syndrome”)?

Microemboli from proximal plaque

5 P’s of acute limb ischemia?

Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia(body cant control its own internal temp)

Initial management of acute limb ischemia?

Immediate heparinization + urgent vascular surgery consult—>then reestblish perfusion; during reperfusion may get reperfusion injury with swelling→fasciotomy needs to be performed

Neuropathic ulcers?

Due to diabetic neuropathy