Authors:
Sebouh Bazikian - PGY1 at Emory School of Medicine Integrated Vascular Surgery Program
Miguel F. Manzure - vascular surgery attending the University of Southern California Keck School of Medicine involved in complex limb preservation
Core Resources:
- Rutherford Chapters: 107, 108, 109 (Includes further information on anatomy), 112
Additional Resources:
- Relevant trials
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- Relevant Audible Bleeding episodes
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- Anything else useful
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Underlying disease featured in episode - peripheral arterial disease
- Pathophysiology/etiology
- narrowing of peripheral arteries caused by atherosclerotic plaques causing arterial insufficiency distal to the point of occlusion. This reduces oxygen supply to the muscles.
- When oxygen demand increases but cannot be met, it leads to an imbalance such as pain and poor wound healing.
- Risks: smoking, diabetes, hypertension, dyslipidemia, and older age
- Equal prevalence in men and women, peak incidence age 60-80
- Coexists with CAD, DM, stroke, Afib, and renal disease
- Patient Presentation
- 20-50% asymptomatic, rest can be intermittent claudication, rest pain, or tissue loss
- claudication=pain or discomfort felt in the legs due to a lack of blood flow, especially during physical activity.
- CLTI=chronic limb threatening ischemia: rest pain lasting greater than 2 weeks or nonhealing ulcers and gangrene
- Physical exam:
- decreased skin temperature, less hair on the legs, brittle nails, atrophied muscles, shiny skin, livedo reticularis.
- Absent or diminished pulses
- Buerger sign
- Diagnosis
- Ankle brachial index: