peripheral vascular disease, occlusive arterial disease, management

1. Joel Arudchelvam

2. Peripheral arteries
 Arteries outside of chest and abdomen
 Diseases
 Occlusive [OAD]
 Aneurysmal
 Inflamatory
 Others

3. OAD
Causes
 Atheromatous
 Risk Factors
 Smoking
 Diabetes
 Hypertension
 Hyperlipidemia
 Advanced age
Inflammatory
Trauma

4. Presentation
• Claudication
• Rest pain
• Ulcer
• Gangrene

5. Examination
Vascular - pulse status

6. Pulse strength
0 - no pulse
1 - faint pulse
2 - diminished than normal
3 - normal
4 - bounding

7. Examination
Ankle Brachial Pressure index - ankle perssure/
Brachial pressure
Normal – 0.9 to 1.3

8. Lower limb arteries

9. Pulse status and possible sites
of occlusion

10. Pulse status and possible sites of
occlusion
Aorto iliac
disease

11. Pulse status and possible sites
of occlusion
Fem-pop
disease

12. Pulse status and possible sites of occlusion

13. Investigations
 General
FBC,SCR,SE,FBS,LIPID PROFILE
To localise and to plan intervention
USS + DOPPLER
CT/MR ANGIOGRAPHY

14. Management
Medical
Graded exercises
Aspirin
Lipid lowering drugs
Cilostazol
Pentoxifylline
Foot care
Aggressive control of co-morbid diseases

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

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

17. Bypass

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

19. Outcome
Major cause of mortality in PVD is cardiac and
cerebrovascular disease

20. THANK YOU