Ver el código de «Peripheral artery disease»

''See [[acute arterial ischemia]] for acute limb ischemia''
==Background==
*Peripheral artery disease = ABI <0.9 (normal ≥1.0)<ref>Heald CL, et al. Ankle Brachial Index C. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189:61–69.</ref>
*>70% of patients are either former or current smokers<ref>Ng EL, et al. Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department. Vascular. 2014; 22(1):1-12.</ref>
*33% of deaths are from reperfusion injury
**Myoglobinemia, ARF, increased CK
*Thrombosis accounts for >80% of lower limb ischemia
*PAD indicates systemic atherosclerosis<ref>Levy PJ. Epidemiology and pathophysiology of peripheral arterial disease. Clin Cornerstone. 2002;4:1–15.</ref> 

==Clinical Features==
[[File:Arterial ulcer peripheral vascular disease.jpg|thumb|Svere peripheral arterial disease with chronic dorsal foot ulceration.]]
[[File:Two ischaemic ulcers on the foot of an individual with type 2 diabetes.jpg|thumb|Two ischemic ulcers: second toe (large) and first toe (small).]]
[[File:NecrosisDuetoPAD.jpg|thumb|Peripheral arterial disease resulting in necrosis of multiple toes]]
*Shiny, hyperpigmented skin, hair loss
*Ulceration
**Tend to be on foot/toes, more painful than venous ulcers
*Cap refill >3sec

==Differential Diagnosis==
*[[Phlegmasia Alba Dolens]]
*[[Phlegmasia Cerulea Colens]]
*[[Ankle fracture]]
*[[Venous thromboembolism]]

{{Foot diagnoses}}

==Evaluation==
===ABI===
*Measuring
*#Position patient supine
*#Measure SBP from both brachial arteries using cuff and handheld Doppler over the AC fossa
*#Measure SBP from both DP and PT arteries using cuff placed just proximal to the malleoli with Doppler over artery (5-8% of normal patients have absent DP pulse)
*#Calculate ABI on each leg by taking the highest ankle SBP divided by the highest brachial SBP and record to 2 decimal places
*Using calculation
**0.91–1.30: normal
**0.70–0.90: mild occlusion
**0.40–0.69: moderate occlusion
**<0.40: severe occlusion
**>1.30: poorly compressible/calcified vessels
===Imaging===
*Xray
**Little use or benefit
*Ultrasound
**Accurate for detecting obstruction in femoral/popliteal/bypass grafts
***Sn declines at/below the calf
**Quality of signal (triphasic, biphasic, monophasic) is important to note
*CTA
**Sensitivity similar to that of conventional angiography
*MRI
**Limited utility in the ED setting
**Detailed images of vasculature can be taken and plaques identified

==Management==
*Chronic PAD can recieve outpatient management (by vascular)

==Disposition==
*Chronic PAD can be managed as an outpatient

==See Also==
*[[Foot Diagnoses]]
*[[Vascular injury]]

==External Links==
*[http://stanfordmedicine25.stanford.edu/the25/ankle.html Stanford Medicine 25: Measuring ABI]

==References==
<references/>

[[Category:Vascular]]
[[Category:Trauma]]
[[Category:Surgery]]