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Peripheral artery disease
From WikEM
(Redirected from Limb ischemia)
See acute arterial ischemia for acute limb ischemia
Contents
Background
- Peripheral artery disease = ABI <0.9 (normal ≥1.0)[1]
- >70% of patients are either former or current smokers[2]
- 33% of deaths are from reperfusion injury
- Myoglobinemia, ARF, increased CK
- Thrombosis accounts for >80% of lower limb ischemia
- PAD indicates systemic atherosclerosis[3]
Clinical Features
- Shiny, hyperpigmented skin, hair loss
- Ulceration
- Tend to be on foot/toes, more painful than venous ulcers
- Cap refill >3sec
Differential Diagnosis
Foot diagnoses
Acute
- Foot and toe fractures
- Subtalar dislocation
- Metatarsophalangeal sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Tinea pedis
Evaluation
ABI
- Measuring
- Position patient supine
- Measure SBP from both brachial arteries using cuff and handheld Doppler over the AC fossa
- Measure SBP from both DP and PT arteries using cuff placed just proximal to the malleoli with Doppler over artery (5-8% of normal patients have absent DP pulse)
- Calculate ABI on each leg by taking the highest ankle SBP divided by the highest brachial SBP and record to 2 decimal places
- Using calculation
- 0.91–1.30: normal
- 0.70–0.90: mild occlusion
- 0.40–0.69: moderate occlusion
- <0.40: severe occlusion
- >1.30: poorly compressible/calcified vessels
Imaging
- Xray
- Little use or benefit
- Ultrasound
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- Sn declines at/below the calf
- Quality of signal (triphasic, biphasic, monophasic) is important to note
- Accurate for detecting obstruction in femoral/popliteal/bypass grafts
- CTA
- Sensitivity similar to that of conventional angiography
- MRI
- Limited utility in the ED setting
- Detailed images of vasculature can be taken and plaques identified
Management
- Chronic PAD can recieve outpatient management (by vascular)
Disposition
- Chronic PAD can be managed as an outpatient
See Also
External Links
References
- ↑ Heald CL, et al. Ankle Brachial Index C. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189:61–69.
- ↑ Ng EL, et al. Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department. Vascular. 2014; 22(1):1-12.
- ↑ Levy PJ. Epidemiology and pathophysiology of peripheral arterial disease. Clin Cornerstone. 2002;4:1–15.
