PAD

  • manage risks: e.g. smoking cessation
  • initial management: supervised exercise program best for claudication
    • 30-45 minutes of supervised walking >3 times a week for >3 months
    • Once the walking time required to develop claudication is determined, the sessions are gradually increased until the patient can walk for a longer period without developing symptoms.
    • Patients may experience moderate increases in symptom-free walking distance.
  • Pharm: antiplatelet and statin
  • twice daily cilostazol can help with symptoms
  • revascularization via stent or bypass reserved for critical limb ischemia

Limb Ischemia

  • acute limb ischemia (ALI)
  • pathogenesis: sudden decrease in limb perfusion, often caused by acute arterial occlusion due to systemic embolism from a cardiac source (eg, atrial fibrillation, left ventricular thrombus, or septic emboli from infective endocarditis).
  • sx: six P's of acute ischemia: pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis.
    • severe resting pain with sensory/motor loss
    • delayed capillary refill
    • no doppler signals
  • imaging: CT angiography, duplex US, MRA for patients with viable ALI
  • rx:
    • anticoagulation, IV heparin bolus with infusion
    • emergent surgical revascularization or catheter based thrombolytics