Peripheral arterial occlusive disease

1. Peripheral Arterial
Occlusive Disease
(PAOD)
Dr. Mansoor Khan, MBBS, FCPS-I, PGY2 (Surgery)

2. “ Atherosclerosis of the arteries of
extremities resulting in exercise
induced ischemia, ulcers and
gangrene of in the limbs”

3. Atherosclerosis affects up to 10% of the
Western population older than 65 years
12.2% required amputation
Predicted mortality rates for patients with
claudication at 5, 10, and 15 years of follow-up
are approximately 30%, 50%, and 70%,
respectively.
most commonly manifests in men older than
50 years

4. Peripheral
arterial disease

5. Arterial stenoses
resting blood flow is similar to that of a healthy
personblood flow cannot maximally (10 folds normally)
increase in muscle tissue metabolic demands of the
muscle exceed blood flow, claudication symptoms ensue

6. In healthy person
ankle pressure higher than arm pressure.
during exercise no change in blood pressure
Atherosclerotic limb
reduce the pressure in distal muscle groups.
at rest, the measured blood pressure at the ankle is
less than that of a healthy person

7. Poiseuille equation
pressure = Q8vL/kr4
Pressure gradient directly to flow and length of stenosis
Inversely proportional to the fourth power of the radius.

8. The risk factors for PAOD
diabetes, hypertension, hyperlipidemia,
family history, sedentary lifestyle, and tobacco use

9. Smoking
Greatest of all the cardiovascular risk factors
Damage is directly related to the amount of used.
Counseling patients on the importance of smoking
cessation is paramount in management.

10. Claudication, defined as reproducible ischemic
muscle pain, is one of the most common
manifestations of peripheral vascular disease
Rest pain

11. Ulcer on the toes, web spaces,

12. Ischemic gangrenes of the toes, web
spaces,

13. General Physical Examination
Atrophy of calf muscles, loss of extremity hair,
and thickened toenails are clues to underlying
peripheral arterial occlusive disease (PAOD).

14. Pulses
Palpation of pulses from the abdominal aorta to the foot,
Auscultation for bruits in the abdominal and pelvic regions
Absence of a pulse signifies arterial obstruction proximal
to the area palpated.

15. When pulses are not present, further assessment of
with a handheld Doppler device.
An audible Doppler signal assures some blood flow
No Doppler signals, a vascular surgeon should be
immediately consulted

16. Ankle-brachial index (ABI),
ratio of systolic blood pressure at the ankle to the arm.

17. 0.7 to 0.9 is mild disease,
0.5 to 0.69 is moderate disease,
< 0.5 is severe disease.

18. Ankle Brachial Pressure
Index (ABI)

19. Angiography

20. Angiography

21. Duplex ultrasound scanning

22. MR-Angiography

23. Other Helpful Tests:
Fasting lipid profile,
Fasting blood glucose
levels,
Homocystein level

25. Risk factors modification
(strict control of HTN, DM and
Lipids)

26. Exercise Program
– is the most effective
1 hour/ week, 2-3 times daily, gradually increases
with tolerance

27. Exercise pyramid for Healthy life

28. Smoking cessation counselling

29. Pharmacological therapy (Aspirin, clopidogril, pentoxfylline)

30. Stenting

31. Angioplasty

32. Autologous venous grafting