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Dr.AbdulAziz Al Muzaini

Students. Dr.AbdulAziz Al Muzaini. PAD. Arterial Disease. Anatomy. Dr.A.Al -Muzaini. Risk Factors for PAD. Arterial Disease. Family H/O CAD, PAD, CVA. Personal H/O CAD, MI. Known arterial disease. Stroke. Diabetes. Hypertension. Hyperlipidemia. Tobacco Abuse. Dr.A.Al -Muzaini.

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Dr.AbdulAziz Al Muzaini

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  1. Students Dr.AbdulAziz Al Muzaini PAD

  2. Arterial Disease Anatomy Dr.A.Al-Muzaini

  3. Risk Factors for PAD Arterial Disease • Family H/O CAD, PAD, CVA. • Personal H/O CAD, MI. • Known arterial disease. • Stroke. • Diabetes. • Hypertension. • Hyperlipidemia. • Tobacco Abuse. Dr.A.Al-Muzaini

  4. Mode of Examination Arterial Disease • History and physical examination • Physiological testing (ABI, Pressure measurements and Doppler waveforms). • Duplex Sonography. • Angiography (Catheter, MRA and CTA). Dr.A.Al-Muzaini

  5. History and Physical Examination Arterial Disease • Sensitive- moderate and sever arterial insufficiency. • Limited localization of obstruction. Dr.A.Al-Muzaini

  6. Patient History & Examinations Arterial Disease Dr.A.Al-Muzaini

  7. Physiological Testing (ABI, Pressure Measurements and Doppler Waveforms) Arterial Disease • Very sensitive for arterial insufficiency (especially with exercise). • Specific – answer question: are symptoms due to arterial insufficiency? • Semi – quantitative (severity). • Detect progression over time. • Limited localization of obstruction. Dr.A.Al-Muzaini

  8. Peripheral Lower Limb Ischemia Arterial Disease Acute on top of chronic Most common Chronic 5 Ps Acute Critical Rest pain > 2 weeks + trophic changes or low ankle and toe pressure Dr.A.Al-Muzaini

  9. Claudication “To Limp” Arterial Disease • Mild to moderate disease. • Progressive muscular cramping pain with exertion. • Typically in calf, but may be thigh or buttock. • Location dependent upon the site of the lesion(S). • Relieved by rest. • Consistent onset and severity. • Not joint pain. Dr.A.Al-Muzaini

  10. Severe Disease Arterial Disease • Ischemic rest pain 1 2 Ulceration Tissue Necrosis 3 Gangrene 4 Dr.A.Al-Muzaini

  11. Physical Examination Arterial Disease • Thick to nails + crack. • Depended rubber. • Ulcer. • Dry scale skin Dr.A.Al-Muzaini

  12. Dr.A.Al-Muzaini

  13. Noninvasive Assessment of Arterial Disease Arterial Disease • Physiological Testing: - Indirect testing evaluates hemodynamics. - Determine physiological impairment. • Duplex Ultrasound: - Morphologic and physiologic information. • Identifies changes in blood flow patterns due to pathology. - Define location of disease more precisely. Dr.A.Al-Muzaini

  14. Normal Waveform Arterial Disease Dr.A.Al-Muzaini

  15. Waveforms Arterial Disease Biphasic Monophasic Dr.A.Al-Muzaini

  16. Waveform Dr.A.Al-Muzaini Arterial Disease

  17. Segmental Pressure (SLP) Arterial Disease • Compare to contralateral limb same level (Horizontal). • Compare to adjacent segments (Vertical). • ≥ 20 mm/hg pressure gradient (drop) is significant if the ABI is normal. • Can determine region of disease. Dr.A.Al-Muzaini

  18. Arterial Disease Physiological Arterial Testing • Segmental Limb Pressures (SLP): • Compare to brachial pressure • Compare to contralateral limb. • Compare to adjacent segments. Dr.A.Al-Muzaini

  19. Segmental Limb Pressure SLP Arterial Disease Dr.A.Al-Muzaini

  20. Ankle Brachial Index (ABI) Arterial Disease • Normal individual in a supine position, ankle systolic pressure is ≥ Brachial. • Highest ankle pressure divided by the higher brachial pressure. Dr.A.Al-Muzaini

  21. Pressure Measurements and Doppler Arterial Disease • Semi-quantitative: • Normal 0.90 / 1.25 • Claudications - Mild 0.75 - 0.90 - Moderate 0.50 - 0.75 - Sever/Multi level 0.30 - 0.50 • Rest pain < 0.30 • Tissue loss- gangrene 0.0 Dr.A.Al-Muzaini

  22. Dr.A.Al-Muzaini Physiological Arterial Testing • Toe Brachial Index: • Used on patients with incompressible vessels. • Diabetics, chronic renal failure. • Toe BI= 0.7 or greater (normal). • CW Doppler or photocell.

  23. Exercise Testing Arterial Disease • Useful in patients with mildly abnormal resting studies, unusual presentations/symptoms (borderline normal from abnormal). • Differentiate true vascular claudication from “pseudo-claudication’. • Confirm or exclude presences of arterial disease. Dr.A.Al-Muzaini

  24. Vasculogenic claudication Criteria Arterial Disease • Drop in ankle pressure > 20 mm/hg configuring vascular etiology for claudication. • Larger the drop/ longer return to baseline corresponds to lesion severity. Dr.A.Al-Muzaini

  25. Arterial Disease Duplex (Mapping) Dr.A.Al-Muzaini

  26. Dr.A.Al-Muzaini Arterial Disease Case Study

  27. Dr.A.Al-Muzaini Arterial Disease Case Study

  28. Dr.A.Al-Muzaini Arterial Disease Case Study

  29. Dr.A.Al-Muzaini Arterial Disease Case Study

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