occlusive arterial disease by Joel Arudchelvam

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Peripheral Vascular Disease

• Joel Arudchelvam

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Peripheral arteries

• Arteries outside of chest and abdomen
• Diseases
• Occlusive OAD
• Aneurysmal
• Inflamatory
• Others

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OAD

• Causes
• Atheromatous
• Risk Factors
• Smoking
• Diabetes
• Hypertension
• Hyperlipidemia
• Advanced age
• Inflammatory
• Trauma

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Presentation

• Claudication
• Rest pain
• Ulcer
• Gangrene

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Examination

• Vascular - pulse status

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Pulse strength

• 0 - no pulse
• 1 - faint pulse
• 2 - diminished than normal
• 3 - normal
• 4 - bounding

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Examination

• Ankle Brachial Pressure index - ankle
  perssure/ Brachial pressure
• Normal 0.9 to 1.3

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Lower limb arteries
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Pulse status and possible sites of occlusion
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Pulse status and possible sites of occlusion
Aorto iliac disease
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Pulse status and possible sites of occlusion
Fem-pop disease
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Pulse status and possible sites of occlusion
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Investigations

• General
• FBC,SCR,SE,FBS,LIPID PROFILE
• To localise and to plan intervention
• USS DOPPLER
• CT/MR ANGIOGRAPHY

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Management

• Medical
• Graded exercises
• Aspirin
• Lipid lowering drugs
• Cilostazol
• Pentoxifylline
• Foot care
• Aggressive control of co-morbid diseases

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Management

• Indications for intervention
• 1. Disabling claudication
• 2. Rest pain
• 3. Tissue loss

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Management

• Endovascular
• 1.angioplasty and/
• 2.stenting
• Surgical
• 1.Bypass
• 2.Endarterctomy
• Amputation

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Bypass
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Conduits

• 1. Autogenous
• saphenous vein
• 2. Synthetic
• PTFE
• DACRON(polyester)

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Outcome

• Major cause of mortality in PVD is cardiac and
  cerebrovascular disease

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• THANK YOU