peripheral arterial disease - ascension health• supervised physical therapy • 3 months and...
TRANSCRIPT
![Page 1: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/1.jpg)
![Page 2: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/2.jpg)
Peter P. Monteleone, MD
Peripheral Arterial Disease Diagnosis and Treatment of the Ischemic Limb
![Page 3: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/3.jpg)
![Page 4: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/4.jpg)
To that end…
• Claudication
• Criticallimbischemia(CLI)
• Acutelimbischemia(ALI)
![Page 5: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/5.jpg)
Before we get there… Scope and the “incidence of PAD”
• Whodoweevenneedtosort?
• Howdowedefinethepopulationofpatientswithperipheralarterialdisease?
• Weknowitwhenweseeit…• Buthowwouldwelookforit?• Andshouldwelookforit?
• Anklebrachialindexasatestablesurrogate?
![Page 6: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/6.jpg)
ABI/PVR
![Page 7: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/7.jpg)
Segmental ABI
![Page 8: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/8.jpg)
Segmental ABI
>1.4-non-compressible
0.91-1.4-“normal”
0.71-0.9-mildPAD
0.41-0.7-moderatePAD
0-0.4-severePAD
![Page 9: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/9.jpg)
What a straightforward… easy to perform… inexpensive test! Should we screen everyone with an ABI?
![Page 10: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/10.jpg)
If the question is…
• ShouldwescreeneveryonewithanABIsothateveryonewithasevereblockagecangetastentorabypass?
• theanswerisastrongNO
• ShouldwescreeneveryonewithanABIsothateveryonewithPADcanbemedicallytreatedtopreventanincreasedriskofcardiovascularmorbidity/mortality?
• TheanswerisastrongMAYBE
![Page 11: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/11.jpg)
USPTF 2014
![Page 12: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/12.jpg)
USPTF 2014
![Page 13: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/13.jpg)
Like we said…
• “Astrongmaybe”
![Page 14: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/14.jpg)
If you look at ABIs… you will find PAD…
![Page 15: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/15.jpg)
And if you find it… it will mean something…
AnABI<=0.90wasassociatedwithapproximatelytwicetheage-adjusted10-yeartotalmortality,cardiovascularmortality,andmajorcoronaryevent
ratecomparedwiththeoverallrateineachFRScategoryAnklebrachialindexcombinedwithFraminghamriskscoretopredictcardiovasculareventsandmortality:ameta-analysis.JAMA.2008;300:197–208.
![Page 16: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/16.jpg)
![Page 17: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/17.jpg)
ACC/AHA 2017 Guideline
![Page 18: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/18.jpg)
ACCAHAGuidelines
![Page 19: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/19.jpg)
Not back to symptomatic LE PAD…
![Page 20: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/20.jpg)
![Page 21: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/21.jpg)
Categorizing lower extremity ischemia
• Claudication
• Criticallimbischemia(CLI)
• Acutelimbischemia(ALI)
![Page 22: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/22.jpg)
Categorizing lower extremity ischemia
• Claudication
• Criticallimbischemia(CLI)
• Acutelimbischemia(ALI)
![Page 23: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/23.jpg)
The claudication to CLI “spectrum”
![Page 24: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/24.jpg)
The claudication to CLI “spectrum”
![Page 25: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/25.jpg)
The claudication to CLI “spectrum”
CRITICALLIMBISCHEMIA
![Page 26: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/26.jpg)
Claudication
• Supply&demandmismatch
• 99.9%historytaking• Naturalhistory• Treatmentoptions
![Page 27: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/27.jpg)
Claudication
• Supply&demandmismatch
• 99.9%historytaking• Naturalhistory• Treatmentoptions
![Page 28: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/28.jpg)
Natural history key points
• Lowerextremityamputationrate2-5%at5years
• But5yearmortalityrateupto30%(primarilycardiac)
![Page 29: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/29.jpg)
Follow those 2 points forward
• Amputationrateaslowas2%dictateshowaggressivewearewiththelimbprocedurally
• 5yearmortalityrateashighas30%dictateshowaggressiveyouMUSTbewithpreventativemedicaltherapies
![Page 30: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/30.jpg)
Treatment for patients with PAD (not just “treatment of PAD”)
• Diet/exercise• Tobaccocessation• Supervisedphysicaltherapy
• 3monthsandsignificantQOL&walkingdistances
• GDMTforBPcontrol• Highdosestatintherapy• ASAforMACEreduction• OR(notand)clopidogrel(seeCAPRIE/CHARISMA)• Cilostazoltoincreaseambulation(PDEIIIinhibitorcontraindicatedinCHF)
![Page 31: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/31.jpg)
What about anticoagulation & the COMPASS trial?
![Page 32: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/32.jpg)
Compass (peripheral)
![Page 33: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/33.jpg)
NNT=50 NNT=100
NNH=50
![Page 34: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/34.jpg)
NNT=50 NNT=100
NNH=50
• Notyetinguidelines
• Bayersponsoredtrial
• “Verylowdose”availability?
![Page 35: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/35.jpg)
So which claudicants should you refer for revascularization?
• True“lifestyle-limitingclaudication”• Differentfordifferentpeople
• Donot“procedurallyconvertthebenignnaturalhistoryofthediseasetosomethingmoremalignant”
• Rememberthat5yearamputationrateofaslowas2-5%
![Page 36: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/36.jpg)
![Page 37: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/37.jpg)
![Page 38: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/38.jpg)
Claudication
• Therighttreatmentfortherightpatient
• PreventativemedicaltherapytodecreaseriskofMACE
• Targetedrevascularizationfor“life-limitingclaudication”
![Page 39: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/39.jpg)
![Page 40: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/40.jpg)
Categorizing lower extremity ischemia
• Claudication
• Criticallimbischemia(CLI)
• Acutelimbischemia(ALI)
![Page 41: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/41.jpg)
Back to CLI
• Thoughona“spectrum”withclaudication,amuchmoreseverenaturalhistory
• PatientswithCLI(restpainortissueloss)with%amputationrateat6-12months
• Versus2-5%amputationrateat5yearswithclaudication
• s/pBKAforCLIwith48%mortalityat2years
• s/pBKAonly4%ambulatingat2years
![Page 42: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/42.jpg)
Diagnosis
• Historyandphysical• NormalABIdoesnotruleoutanischemicwoundetiology
• “30%ofCLIpatientsw/restABIbetween0.7and1.4”inINPACT-DEEPDEBCLIstudy
• Thinkaboutanatomyandthe“angiosome”
![Page 43: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/43.jpg)
43
![Page 44: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/44.jpg)
![Page 45: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/45.jpg)
![Page 46: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/46.jpg)
![Page 47: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/47.jpg)
Urgent treatment
• Considerthedifferentialdiagnosisofwounds• Urgentvascularreferral(w/woundcare)• Delineationofanatomy
• RestABI/PVR(thoughimperfect)
• Vascularultrasound• ?maybeCTA(considerrenalfunction)
• Angiography
• Evaluationforunderlyinginfection/osteomyelitis
![Page 48: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/48.jpg)
Revascularize
• Urgentrevascularization
![Page 49: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/49.jpg)
Revascularization options
• Endovascularversussurgical• BEST-CLIongoing• ?avoidcreatingasurgicalbypasswoundtotreatanon-healingwound
• Noveltechniques• Atherectomy,DEB,below-kneerevasc,retrogradeaccess
• Doanythingyoucantosavethelimborconverttoalesseramputation
![Page 50: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/50.jpg)
The battle of the cath lab ends but the war has just begun…
• Closefollowup• Anti-platelettherapies• EXCELLENTwoundcareaboveallelse• Avoidanceoffurtherinjury(offloadingshoes)• Medicaloptimization(tobaccocessation!)
![Page 51: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/51.jpg)
Categorizing lower extremity PAD
• Claudication
• Criticallimbischemia(CLI)
• Acutelimbischemia(ALI)
![Page 52: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/52.jpg)
ALI is different…
![Page 53: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/53.jpg)
I will deny the existence of the following slide…
![Page 54: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/54.jpg)
Categorizing lower extremity PAD
• Claudication……………………………….Angina
• Criticallimbischemia(CLI)…………ACS(UA/NSTEMI)
• Acutelimbischemia(ALI)………….STEMI
![Page 55: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/55.jpg)
Finally the 6 P’s
![Page 56: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/56.jpg)
When you suspect ALI
• Thinksomethinghashappenedrapidly
• Alimbisdying
• Itneedstobetreatedequallyrapidly
![Page 57: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/57.jpg)
Consider certain circumstances
• Mostcommonlyarevascularizationthathasfailed• Surgicalgraftgoesdown• Stentthromboses
• Rememberthromboembolicdisease• AtrialfibrillationorpostanteriorMIandcardiacthrombusembolization
• DVTandintracardiacshunt• Hypercoagulablestates(HITT,lupusanticoag,?hyperhomocysteine
![Page 58: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/58.jpg)
Concurrent diagnosis/treatment
• Allimportantphysicalexam/Dopplerpulses
• Anticoagulatewithheparin• Arterialultrasound,oftenCTAespeciallywhenembolicphenomenonisaconcern
• Oftenthefirsttestistheangiogram
• Revascularizeemergently
![Page 59: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/59.jpg)
ALI Evaluation
![Page 60: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/60.jpg)
Evaluation
![Page 61: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/61.jpg)
Evaluation
GOES1ST
GOES2N
D
![Page 62: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/62.jpg)
Take home points…
![Page 63: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/63.jpg)
ABI
• PADasdiagnosedevenbyscreeningABIisassociatedwithincreasedcardiovascularrisk
• Debatere:useoftrue“screeningABI”• “Atherosomewhereisatheroeverywhere”
![Page 64: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/64.jpg)
Claudication
• Claudicationcarriesarelativelylowriskofamputation(“benignnaturalhistory”)butisassociatedwithaveryrealriskofcardiovasculareventsincludingmortality
• Thereforeaggressivelymedicallymanageyourclaudicants
• Patientswith“lifestyle-limitingclaudication”benefitfromrevascularization+exercisewithimprovedwalkingdistanceandrealQOLimprovement
![Page 65: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/65.jpg)
CLI
• Ischemicrestpainand/ortissuelossmeanCLI
• CLIamputationratesupto50%at6-12months
• s/pBKAforCLIwith50%mortalityat2yearsandonly4%ambulating
• BeaggressivewithrevascularizationforCLIwhenappropriate
• Exceptionalfollowupandwoundcarerequired
![Page 66: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/66.jpg)
ALI
• ALIisanacutelydyinglimb
• Rememberpost-procedureandthromboembolicetiologies
• Anticoagulate,diagnoseandtreat
![Page 67: Peripheral Arterial Disease - Ascension Health• Supervised physical therapy • 3 months and significant QOL & walking distances • GDMT for BP control • High dose statin therapy](https://reader031.vdocuments.net/reader031/viewer/2022041904/5e62aae0f7fcde41e459e633/html5/thumbnails/67.jpg)
Questions?
Peter Monteleone, MD Interventional Cardiology Vascular Medicine & Intervention Pedro Teixeira, MD Vascular Surgery