1. Peripheral Arterial Occlusive Disease (PAOD) Dr. Mansoor Khan, MBBS, FCPS-I, PGY2 (Surgery)

2. “ Atherosclerosis of the arteries of extremities resulting in exercise induced ischemia, ulcers and gangrene of in the limbs ”

3. Atherosclerosis affects up to 10% of the Western population older than 65 years 12.2% required amputation Predicted mortality rates for patients with claudication at 5, 10, and 15 years of follow-up are approximately 30%, 50%, and 70%, respectively. most commonly manifests in men older than 50 years

4. Peripheral arterial disease

5. Arterial stenoses resting blood flow is similar to that of a healthy personblood flow cannot maximally (10 folds normally) increase in muscle tissue metabolic demands of the muscle exceed blood flow, claudication symptoms ensue

6. In healthy person ankle pressure higher than arm pressure. during exercise no change in blood pressure Atherosclerotic limb reduce the pressure in distal muscle groups. at rest, the measured blood pressure at the ankle is less than that of a healthy person

7. Poiseuille equation pressure = Q8vL/kr4 Pressure gradient directly to flow and length of stenosis Inversely proportional to the fourth power of the radius.

8. The risk factors for PAOD diabetes, hypertension, hyperlipidemia, family history, sedentary lifestyle, and tobacco use

9. Smoking Greatest of all the cardiovascular risk factors Damage is directly related to the amount of used. Counseling patients on the importance of smoking cessation is paramount in management.

10. Claudication , defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral vascular disease Rest pain

11. Ulcer on the toes, web spaces,

12. Ischemic gangrenes of the toes, web spaces,

13. General Physical Examination Atrophy of calf muscles, loss of extremity hair, and thickened toenails are clues to underlying peripheral arterial occlusive disease (PAOD).

14. Pulses Palpation of pulses from the abdominal aorta to the foot, Auscultation for bruits in the abdominal and pelvic regions Absence of a pulse signifies arterial obstruction proximal to the area palpated.

15. When pulses are not present , further assessment of with a handheld Doppler device. An audible Doppler signal assures some blood flow No Doppler signals, a vascular surgeon should be immediately consulted

16. Ankle-brachial index (ABI), ratio of systolic blood pressure at the ankle to the arm.

17. 0.7 to 0.9 is mild disease, 0.5 to 0.69 is moderate disease, < 0.5 is severe disease.

18. Ankle Brachial Pressure Index (ABI)

19. Angiography

20. Angiography

21. Duplex ultrasound scanning

22. MR-Angiography

23. Other Helpful Tests: Fasting lipid profile, Fasting blood glucose levels, Homocystein level

25. Risk factors modification (strict control of HTN, DM and Lipids)

26. Exercise Program – is the most effective 1 hour/ week, 2-3 times daily, gradually increases with tolerance

27. Exercise pyramid for Healthy life

28. Smoking cessation counselling

29. Pharmacological therapy (Aspirin, clopidogril, pentoxfylline)

30. Stenting

31. Angioplasty

32. Autologous venous grafting