Peripheral Artery Disease

#med #disease #y2023

Presentation :

Resting ABI should be performed on all patients with a history or physical examination suggesting PAD
- Normal ABI is >0.9 to ≤1.40.
- ABI ≤0.90 is compatible with PAD
- For pts with ABI >1.40, this likely results from calcified, noncompressible arteries.
  - These patients should proceed to toe-brachial index; <0.70 indicates PAD
Exercise treadmill ABI testing should be performed for patients with normal or borderline resting ABI values and unexplained exertional leg symptoms
Noninvasive angiography with duplex ultrasonography, CTA, or MRA is performed for anatomic delineation of PAD in patients requiring surgical or endovascular intervention.

Exercise training is the most effective treatment for improvement in functional status in patients with PAD.
Optimize CAD risk as per usual:
- smoking cessation
- BP goal <130/80 mm Hg
- aspirin (preferred over clopidogrel)
- moderate- or high-intensity statin therapy
- cilostazol for patients with intermittent claudication
  - AVOID in patients with a low LVEF or history of HF
PCI or surgery for patients who do not improve with medical therapy OR have pain at rest OR poorly healing ulcers.
- Patients with acute limb ischemia require heparin anticoagulation as well as urgent surgical consultation.