Peripheral Artery Diseases

Aldo Ferly

Supervisor:
dr. Taofan Siddiq, Sp.JP(K)
 Peripheral Artery Disease
Presence of flow-limiting lesion in artery that
provides blood supply to the limbs.

It Is very important to learn peripheral artery

disease….

European Society of Cardiology. Gudelines on the Diagnosis and

Treatment of Peripheral Artery Disease. 2011. Accessed 2013 Jan
15
 Implications
• Same risk factors w/ atherosclerosis
 Implications
• Almost 20% has coronary artery diseases

Underdiagnosis

Source: T Mirsch, MH Criqui, D Treat-Jacobson. Peripheral Arterial

Diseases Detection, Awareness and Treatment in Primary Care.
JAMA. 2001
 Awareness still low

49%

Source: T Mirsch, MH Criqui, D Treat-Jacobson. Peripheral Arterial

Diseases Detection, Awareness and Treatment in Primary Care.
JAMA. 2001
 What causes PAD?
Peripheral
Atherosclerosis Atherosclerotic
Vascular Disease

Mechanic cause Thromboembolism

Inflammation Vasculitis
 Peripheral Atherosclerotic Vascular
Disease : Clinical Presentations
• Claudication
– Buttocks, thight, calf discomfort prescipitated by
walking and relived by rest
 Clinical Presentation

Watch out for secondary bacteria infection!

What to do as primary care physician?
• Calculate Angkle-Brachial Index
– Measure BP in ankles (left right) and arms(left
right)
– Get the systolic value
– Divide the ankle pressure with arm pressure
 Interpretation
• Normal : ABI>=1.0
• <0.9  diagnostic PAD, claudication
symptoms
• <0.5  severe pain at rest
 Treatment
Prevention of cardiovascular events
• Non-medical treatment
– Risk factor modification
• Medical treatment
– Antiplatelet therapy : aspirin
 Treatment
For the foot itself
• Non-medical treatment
– Exercise program
 Exercise Regiment

Source: Hamburg N, Balady G. Exercise Rehabilitation in Peripheral

Artery Disease: Functional Impact and Mechanism of Benefits.
Circulation. 2011; 123: 87-97
ACUTE ARTERIAL OCCLUSION
 Acute Arterial Occlusion
Embolization materials from cardiac/non-cardiac
origin in distal artery
 Origins of Emboli
• Cardiac origin
– Stagnant left atrial flow
– Left ventricle mural thrombus
– Valvular lesions
– Left atrial myxoma
• Aortic origin
– Thrombus from atherosclerotic segment
• Venous origin
 Diagnosis
• 6 P:
– Pain
– pallor
– paralysis
– parasthesia
– pulselessness
– poikilothermia
VASCULITIS SYNDROME
 Definition
• Immune depsoition on the vessel wall
 Diseases
• Takayatsu arteritis
• Giant cell arteritis
• Buerger Disease
 Takayatsu Disease
• 1.2 in 1.000.000 people
• 90% in women
• Affect Aorta
• Signs : Puselessnes
• Treatment: Steroid and cytotoxic drug
 Giant Cell arteritis
• Affect medium to large blood vessels
 Epidemiology
• 24 in 100,000 people
• After age 50
• 65% female
 Signs and Symptoms
• Depends on the location
– Temporal artery : prominent headache
– Facial artery: facial pain, jaw pain when chewing
– Opthalmic artery: impaired vision (blidness in
20%)
 Diagnosis
• Ultrasound
• Biopsy
 Treatment
• Self limiting
• High-dose steroid
 Buerger Disease
• Distal vessels on upper/lower extremities
 Epidemiology
• Men <45 years old
• Cigarette smoking is a huge risk factor
 Signs/Symptoms
• Distal arterial occlusion
• Raynaud phenomenon
• Migrating superficial vein thrombophlebitis

Source: Lilly, LS. Lily’s Patophysiology of Heart Disease. 5th Edition. Wolters
Kluwer Health: Philadelphia. P. 346-349
 Treatment
• Smoking cessation
• Debridement of necrotic tissue
 Reference
1.T Mirsch, MH Criqui, D Treat-Jacobson.
Peripheral Arterial Diseases Detection,
Awareness and Treatment in Primary Care.
JAMA. 2001
2.Hamburg N, Balady G. Exercise Rehabilitation
in Peripheral Artery Disease: Functional Impact
and Mechanism of Benefits. Circulation. 2011;
123: 87-97
3.Lilly, LS. Lily’s Patophysiology of Heart Disease.
5th Edition. Wolters Kluwer Health: Philadelphia.
P. 346-349