Peripheral Arterial Disease in afya

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''Mx''
Useful - Antiplatelet agents (aspirin / clopidogrel - beware bleeding) and statins (if Sx, lower LDLc to < 2.59 and if other vascular disease < 1.81)
Also - exercise (supervised programme if poss) and stop smoking
BP <140/90 (if diabetic / CKD <130/80) - ACE best or thiazides
aggressice glc control - doesn't help arteries
other drugs do exist (cliostazol (SE headache, CVS events), pentoxifyline (GI upset))
 
Percutaneous angioplasty - transient benefit only with possible nephrotoxicity (2ndary to contrast esp if pre-exisiting renal failure, dehydration, CCF, NSAID) and bleeding / aneurysm
Bypass surgery - consensus view of benefit but no long term RCT (serious risks quite high (8%))
 
Significant ''narrowing of arteries'' - usually due to athersclerosis
Sx - intermittent claudication to critical ischaemia (rest pain, ulcer, gangrene)
severity - 1 - aSx, 2a initial claudication at >200m, 2b <200m, 3 rest / nocturnal pain, 4 - gangrene
 
''over 50'' - 10-20% of people
risk factors - age, sex, //smoking, diabetes//, HT, hyperlipid, obese, inactive
acute ischaemia - thrombus or embolus - urgent referral
drugs reducing peripheral blood flow - Clonidine, Ergotamine, Cyclosporin, Cocaine (?BB)
 
''Prognosis'' - variable - resolve / stable / progress
15% of people with IC get critical ischaemia each year
20% get MI or stroke (non-fatal)
CVD major cause of death - so treat globally

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