Peripheral Arterial
Disease :PAD
Introduction
PAD caused by atherosclerotic occlusion of
arteries to legs
Prevalence 12% and increases to 20% if persons
older than 70 yr.
Affects men and women equally
pt. with PAD , even absence of Hx of MI or
ischemic stroke have same relative risk of death
from CVS cause as pt. with Hx of CAD or CVD
Introduction
Rate of death of all causes equal in men and
women and is elevated even in asymptomatic
pt.
Severity of PAD is closely associated with risk
of MI , ischemic stroke , and death from
vascular cause
Lower ABI – greater risk of CVS events
Critical leg ischemia – mortality of 25%
RISK
FACTOR
 Smoking
 DM
 HT
 Hypercholesterolemia
Normal Artery and
Artery With Plaque Buildup
PAD
 Male
 Female
4%
8%
 Risk Factor



Age
DM > 12 yrs
HT
in THAILAND
A Life
Threatening Condition
 The REACH (Reduction of Atherothrombosis
for Continued Health) Registry has expanded
mortality associated with PAD
 At one year, 19% of the PAD population had
experienced either an MI, a stroke or were
hospitalised for an atherothrombotic event or
had died from CV causes compared to 10% of
the CAD population and 7% of CVD
population.
PAD vs





DM
DM ทำให้เพิ่มควำมชุกของ PAD 2เท่ำ
1.5% ของผูป้ ่ วย DM จะถูกตัดนิ้ ว ขำ
50% จะถูกตัดเพิ่ม
50% ถูกตัดอีกข้ำง ภำยใน 2 ปี
50% ที่ถกู ตัดขำ เสียชีวติ ภำยใน 5 ปี
Clinical
Staging
of
LEAD
Screening
for
PAD
 ABI
 Selection of patient high risk

DM
 Age 50 years.
Ankle-Brachial Index (ABI)
INTERPRETATION
 NORMAL




0.9 -1.30
MILD
0.7-0.89
MODERATE
0.4-0.69
SEVERE
< 0.4
POORLY COMPRESSIBLE
> 1.3
TREATMENT
 งดสูบบุหรี่
 ออกกำลังกำย
 ควบคุม ควำมดัน (140/90 mmHg)




LDH < 100
Medication
Endovascular treatment
Surgery
กำรประเมินผูป้ ่ วยที่มีอำกำร Claudication
ผูป้ ่ วยทีม่ อี ำกำรแบบ classic claudication
ตรวจร่ำงกำยระบบหลอดเลือด
ตรวจ resting ankle - brachial index (resting ABI)
ABI ≤ 0.90
ABI > 0.90
- Exercise ABI
- Toe-brachial index
- Segmental pressure
measurement
- Duplex ultrasound exam.
Confirmation of
PAD diagnosis
- Risk factors
normalization
- Pharmacological risk
Abnormal
results
กำรรักษำภำวะ
claudication
Normal
results
No PAD or
consider arterial
entrapment
syndrome
Intervention
of
PAD
Toe gangrene in a patient with
diabetes
AORTO-ILIAC LESIONS
Lesion
type
Type A
Description
* Unilateral or bilateral stenosis of CIA
* Unilateral or bilateral single short (≤3cm) stenosis of EIA
* Short (≤3cm) stenosis of infrarenal aorta
Type B
* Unilateral CIA Occlusion
* Single or multiple stenosis totaling 3-10cm. Involving the EIA
occlusion not involving the origins of internal iliac of CFA
AORTO-ILIAC LESIONS
Lesion
type
Description
* Bilateral CIA occlusion
* Bilateral EIA stenosis 3-10cm long not extending into the CFA
Type C
* Unilateral EIA stenosis extending tnto the CFA
* Unilateral EIA occlusion that involves the origins of internal iliac and/or CFA
* Heavily calcified unilateral EIA occlusion with or without involvement of origins of internal iliac
and/or CFA
* Infra-renal aorto-iliac occlusion
Type D
* Diffuse disease involving the aorta and both iliac arteries requiring treatment
* Diffuse multiple stenosis involving the unilateral CIA, EIA and CFA
* Unilateral occlusions of both CIA and EIA
* Bilateral occlusion of EIA
* Iliac stenosis in patients with AAA requiring treatment and not amenable to endograft placement or
other laesions requiring open aortic or iliac surgery
FEMORAL-POPLITEAL LESIONS
Lesion
type
Description
* Single stenosis ≤10cm in length
Type A
* Single occlusion ≤5cm in length
* Multiple lesions (stenoses or occlusion),each ≤5cm
Type B
* Single stenosis or occlusion ≤15cm not involving the infra geniculate
popliteal artery
* Single or multiple lesions in the absence of continuous tibial vessels to
improve inflow for a distal bypass
* Heavily calcified occlusion ≤5cm inlength
* Single popliteal stenosis
FEMORAL-POPLITEAL LESIONS
Lesion
type
Type C
Type D
Description
* Multiple stenoses or occlusions totaling >15cm with or
without heavy calcifications
* Recurrent stenoses or occlusion that need treatment
after two endovascular interventions
* Chronic total occlusion of CFA of SFA (>20cm,
involving the popliteal artery)
* Chronic total occlusion of popliteal artery and
proximal trifurcation vessels
THANK
YOU
Question ?