Peripheral artery disease

1. Peripheral Arterial Disease
Presented By:
• Ningthoujam Somalia Chanu
(113)
• Nitya Ranjan Hazarika (114)
• Saddam Hussain (119)
• Zubayur Rahman (125)
• Upendra Mohan Doley (127)

2. Introduction
• PAD is a common circulatory problem in which narrowed
arteries reduce blood flow to limbs.
• Peripheral Arterial
disease (PAD) is an
abnormal Narrowing
of arteries other than
those supplying the
heart or brain.

3. Definition
• PAD is the thickening of the artery walls
that results in a progressive narrowing of
the arteries of the upper and lower
extremities.
• Peripheral Arterial Disease most
commonly affects the legs, but other
arteries may also be involved.
• PAD is a marker of advanced systemic
atherosclerosis.

4. • Early diagnosis and treatment is important in the
treatment to stop the heart disease and stroke.
• This condition may be
reducing blood flow to
the heart and brain as
well.

5. Incidence
• In 2010, 202 million people around the
world were living with PAD.
• The majority of the individual with
PAD(70%) live in low/middle income
regions of the world, including 55 million
individuals in South East Asia & 46 million
in the Western Pacific region.

6. Classification

7. Etiology
• Atherosclerosis: It is the
leading cause of PAD.
It results from the deposit
of cholesterol and lipids
within the vessels walls
and leads to progressive
narrowing of the artery.

8. • Less commonly PAD is also caused by
 Blood vessels inflammation.
 Injury to limbs.
 Unusual anatomy of ligaments or muscles.
 Radiation Exposure.

9. Risk Factors
• Smoking: Single greatest risk factor of
PAD. More than 80-90% of patients with
PAD are current or former smokers.
• Diabetes: DM does this by causing
endothelial and smooth muscle cell
dysfunction in peripheral arteries

10. Other Risk Factors
• Chronic Kidney Disease
• Hypertension
• Hypercholesterolemia
• Family History
• Increasing Age
• Obesity
• Sedentary Lifestyle
• Stress

11. Pathophysiology

12. CLINICAL
FEATURES

13. 1.INTERMITTENT
CLAUDICATION
Cramp like pain felt in the
muscles
Brought on by walking
Not present on taking the first
step of walking
Relieved by standing .

14. 2. REST PAIN
It occurs with limb at rest and felt
in the foot
Worse at night
It is exacerbated by lying down
or elevation of foot.

15. 3. ULCERATION
 It occurs due to arterial
insufficiency and may present
as a painful erosion between
toes
Shallow non-healing ulcers on
the dorsum of the feet

16. 4. GANGRENE
 It occurs due to breakdown of Hb and
formation of iron sulphide
It occurs in two form –
A ) DRY GANGRENE
 It usually affects the most
distal part of the limb
because of arterial
obstruction .
It occurs when the tissues
are desiccated by gradual
slowing of bloodstream.

17. B) WET GANGRENE
 It occurs when
superadded
infection and
putrefaction are
present
Crepitus may be
palpated due to gas
forming anaerobic
microorganism
Example ___
Diabetic foot.

18. 5. DEPENDENT RUBOR OR SUNSET
FOOT SIGN
 Elevation of limb produces pallor which
changes to a red or purple colour when
the limb is allowed to hang down.

19. 6.ARTERIAL PULSATION
DIMINISHED OR ABSENT.
7. ARTERIAL BRUIT.
8. SLOW CAPILLARY REFILLING.

20. INVESTIGATION OF
PERIPHERAL
ARTERIAL DISEASES

21. 1)General: Peripheral vascular disease is a systematic disease , so
full investigation is required and this include:
• Blood picture
•Biochemical investigation
•Lipid profile
•Ecg
•Echocardiography
2) Blood test: Blood test are done to check for conditions related to
PAD , such as high cholesterol level.
3) Radiological:
•Chest x-ray
•Abdominal x-ray (aortic calcification)
•CTA scan
•MRI and MRA ( Magnetic resonance angiography)

22. 4)Doppler Ultrasonography : High frequency sound waves
directed to artery or veins through a hand -held transducer
moved evenly across skin surface
•Audible tone produced in proportion to blood velocity.
•Measure blood flow through vessels.
5)Colored Doppler (duplex scan):Which display a real time
image of the vessel structure.
6) Plethysmography :Is an instrument for measuring changes
in volume, within an organ or whole body ( usually resulting
from fluctuations in the amount of blood or air it contains).

23. 7) Ankle -brachial index :This is a common test
used to diagnosis PAD . It compares the blood
pressure in the ankle with the blood pressure in the
arm.. Blood Pressure readings may be taken before
and immediately after exercising to check the
arteries during walking.
8)Angiography :This test uses x-rays , MRI scan or
CT scan to look for blockages in the arteries .Before
the images are taken , dye(contrast) is injected into
a blood vessels. The dye helps the arteries show up
more clearly on the images.
.

24. 9)Ultrasound of the leg or feet :This test uses
sound waves to see how blood moves through the
blood vessels. Doppler Ultrasound is a special type
of ultrasound used to spot blocked or narrowed
arteries.
10) Brown's Vasomotor index:
• For Buerger's disease
•Test of Vasospasm
• Block the nerves with local anaesthesia to predict
efficacy of sympathectomy.
• Rise in skin temperature is recorded.
• index -->3.5 is positive for sympathectomy.

25. MANAGEMENT :
• General Measures:
1. Stop smoking :Tobacco cessation is
essential to reduce the risk of CVD
events, PAD progression.
2. Reduction of weight,exercise
3. Change in lifestyle, care of feet
4. Control of diabetes and hypertension

26. • Drugs:
1. Antiplatelet therapy should include low dose
aspirin,clopidogrel
2. To treat intermittent Claudication: Cilo-stazol & Pentoxifylline.
• Cilostazol a Phosphodiesterase inhibitors, inhibit platelet
aggregation.
• Pentoxifylline a xanthine derivative decreases fibrinogen
concentration.
3. Heparin is used only in acute phase or embolism

27. •Surgery:
1. PTA: a catheter that contains a balloon at the tip is
moved to the stenosed area of the artery and balloon is
inflated. Plaques should rupture.
If the stenosed area is not dilated adequately with
balloon, stents are used-PTA with stenting.

28. 2.ATHERECTOMY :
It is removal of atheroma either through
open surgery or by percutaneous route
from the wall of the vessels.
3.THROMBECTOMY :
It is removal of thrombus through an
arteriotomy of larger vessels. Done in
aortoiliac, femoropopliteal region.

29. 4.ENDARTERECTOMY :
It is removal of thrombus along with diseased
intima with ten part of media through an
arteriotomy. Endothelium of the vessel is
removed, hence the name.
•Done in carotid,aortoiliac and occasionally
aortofemoral blocks.

30. 5.PERIPHERAL ARTERY BYPASS SURGERY
•Peripheral artery bypass surgery should be
done with an autogenous vein to bypass the
lesion.(long saphenous vein )
•Synthetic grafts are used for long bypasses
such as axillary-femoral
bypass.(polytetrafluoroethylene PTFE,Dacron
garft )

31. 6.AMPUTATION:
•Amputation may be required if tissue
necrosis is extensive gangrene
develops,contracture,or deformity develop .
•Types:
Major – Above knee amputations,below
knee amputation
Minor- distal,transmatatarsal amputation
,etc
Below knee
amputation
Above
knee
amputati
on