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Peripheral Arterial Diseases
Etiology:
- Atherosclerosis secondary to dyslipidemia, hypertension, smoking, diabetes etc
- Thromboembolism
- Antiphospholipid antibody syndrome
- Heparin induced thrombocytopenia
- Myeloproliferative disorders- ET, PV
- Paroxysmal nocturnal hemoglobinuria
- Strong congenital thrombophilia, PNH
- Hyperhomocysteinemia (Role is controversial)
- Vasculitis- Giant cell arteritis, Takayasu disease, thromboangiitis obliterans etc
- Trauma
- Popliteal artery entrapment
- Cystic adventitial disease
- Fibromuscular dysplasia
- Iliac artery endofibrosis
Clinical features:
- Claudication pain
- Progresses to rest pain
Investigations:
- Duplex ultrasonography
- CT angiography
- MR angiography
- Conventional contrast angiography- Useful when concurrent endovascular interventions are planned
Differential diagnosis:
- Lumbar radiculopathy
- Spinal stenosis
- Hip/ knee osteoarthritis
- Myositis
- Venous claudication
Treatment:
- If acute limb ischemia- Start heparin/LMWH followed by surgical/ catheter directed removal of clot
- Control of risk factors such as smoking, dyslipidemia, hypertension, diabetes etc
- Aspirin/ Clopidogrel
- Exercise rehabilitation- Helps in development of collaterals
- For persistent claudication pain/ rest pain- Cilastazol
- Vascular intervention- Transluminal balloon angioplasty/ endovascular stenting
- Surgical bypass using vein grafts
- Prostanoids
- Pentoxyfyllin
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