5 - Peripheral Artery Disease

What are the s/s of PAD?

• can be asymptomatic

• pain/discomfort in affected portion(s) of legs

• intermittent claudication - discomfort or cramping with exertion

• poor wound healing

• erectile dysfunction

What is the diagnostic test & value of PAD?

ankle-brachial index, ≦0.9

What is the distinctive factor of PAD?

ischemia-related exertional leg symptoms, generally increasing with exercise and quickly relived at rest

What are the goals of therapy of PAD?

• alleviate symptoms

• reduce ASCVD risk

• prevent loss of limbs

What are additional clinical goals of PAD?

• increase walking distance, duration, pain-free walking, and overall QOL

• control BP, lipids, glucose

What foot care should be implemented in PAD?

• wear socks & shoes

• closed-toed, well-fitting shoes

• daily inspection of feet, immediate medical attention with swelling, pain, discharge, foul odor, visible bone

What is a recommended PAD exercise program?

walking on a treadmill until moderate-to-maximum claudication symptoms develop, alternating with rest

• 30-45 minutes per session

• 3 sessions/wk

• 6 months

What is the treatment for asymptomatic PAD?

single antiplatelet therapy

• aspirin 74-100mg qd

• clopidogrel (plavix) 75mg qd

What is a contraindication of clopidogrel?

bleeding risk

What treatment should be used in symptomatic PAD with no recent revascularization?

• aspirin or clopidogrel

• aspirin + rivaroxaban (xarelto)

What treatment should be used in symptomatic PAD within 6 months post revascularization?

aspirin + rivaroxaban (xarelto)

What class is cilostazol?

PDE-3 inhibitor

What is the onset of cilostazol?

takes up to 12 weeks to see improvement

What are the ADE of cilostazol?

• headache

• diarrhea

• palpitations/tachycardia

• peripheral edema

• hypotension

What should be monitored in treatment of PAD?

• changes in symptoms

• improvements in QOL

• safety of medications

  • antiplatelets/anticoagulants: bleeding

  • cilostazol: ADE, CBC periodically