PAD

• related: Cardiology

• 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

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• Cardiology
  • PAD
• MSK
  • PAD

• 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