Peripheral Artery Disease in Diabetes Mellitus

Peripheral artery disease in diabetes is a complication of diabetes. It is preventable with good diabetic control. Treatment is mainly surgical.

1. PERIPHERAL ARTERY DISEASE IN DIABETES Dr Nikunj Gattani

2. Contents Introduction Clinical features Ankle brachial index P revention and Treatment Reference

3. Introduction Occlusion of lower extremity arteries Atherosclerosis- leading cause Intermittent claudication and pain Critical limb ischemia- rest pain, tissue loss, gangrene Risk factor for lower limb amputation PAD is risk factor for MI and stroke I nvolvement of distal vasculature is common in DM

4. Clinical Features Claudication- Pain, ache, cramp, numbness or fatigue in muscles - Occurs during exercise and relieved by rest Decreased or absent pulses distal to obstruction Bruits over narrowed artery Muscle atrophy H air loss, thickened nails, smooth and shiny skin, reduced skin temperature, pallor or cyanosis

5. Intermittent Claudication Pseudoclaudication PAD Spinal stenosis, lumbar radiculopathy Pain, tightness, cramping, heaviness, tiredness, burning Same plus tingling, weakness, clumsiness Exercise induced No clear association Distance to claudication same everytime Distance to claudication variable Relieved on standing/stop walking Relieved with sitting down/change in body position

6. Ankle Brachial Index measurement for patency of lower extremity arterial system ratio of systolic blood pressure in ankle and arm early diagnosis of PAD Normal: 0.9 – 1.4 Mild obstruction: between 0.7 and 0.9 Moderate obstruction: between 0.4 and 0.7 Severe obstruction: < 0.4 Vascular calcification: > 1.4

7. Prevention and Treatment Intensive control of glucose is useful only in short duration of diabetes and without preexisting macrovascular disease Control of BP and lipid levels Risk factor modification A ntithrombotic therapy S moking cessation A ntiplatelets Supportive measures Cilostazol- increases claudication distance P entoxifylline- increases blood flow

8. Revascularization MRA, CTA , conventional angiography E ndovascular interventions- Percutaneous transluminal balloon angioplasty, stent placement O perative procedures Aortoilliac disease- Aortobifemoral bypass femoral-popliteal , tibio -peroneal artery disease- Reverse autogenous saphenous vein bypass graft

9. Reference Harrison’s Principles of Internal Medicine API textbook of Medicine

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