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Peripheral Arterial Occlusive Disease (PAOD) ,[object Object]
“   Atherosclerosis of the arteries of extremities resulting in exercise induced ischemia, ulcers and gangrene of in the limbs ”
Atherosclerosis affects up to  10%  of the Western population  older than 65 years  12.2% required amputation   Predicted  mortality rates  for patients with claudication at 5, 10, and 15 years of follow-up are approximately 30%, 50%, and 70%, respectively.  most commonly manifests in  men older than 50 years
In healthy person   ankle pressure higher than arm pressure.  during exercise no change in blood pressure Atherosclerotic limb reduce the pressure in distal muscle groups.  at rest, the measured blood pressure at the ankle is less than that of a healthy person
Poiseuille equation pressure = Q8vL/kr4   Pressure gradient directly to flow and length of stenosis Inversely proportional to the fourth power of the radius.
The risk factors for PAOD   diabetes, hypertension, hyperlipidemia,  family history, sedentary lifestyle, and tobacco use
Smoking  Greatest of all the cardiovascular risk factors  Damage is directly related to the amount of used.  Counseling patients on the importance of smoking cessation is paramount in management.
Claudication , defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral vascular disease
Ulcer on the toes, web spaces,
Ischemic gangrenes of the toes, web spaces,
General Physical Examination Atrophy of calf muscles, loss of extremity hair,  and thickened toenails are clues to underlying  peripheral arterial occlusive disease (PAOD).
Pulses Palpation of pulses from the abdominal aorta to the foot,  Auscultation for bruits in the abdominal and pelvic regions  Absence of a pulse signifies arterial obstruction proximal  to the area palpated.
When pulses are not present , further assessment of  with a handheld Doppler device. An audible Doppler signal assures some blood flow  No Doppler signals, a vascular surgeon should be immediately consulted
Ankle-brachial index (ABI),   ratio of systolic blood pressure at the ankle to the arm.
 
Angiography
Angiography
Duplex ultrasound scanning
MR-Angiography
Other Helpful Tests: Fasting lipid profile, Fasting blood glucose levels, Homocystein level
Risk factors modification (strict control of HTN, DM and Lipids)
Exercise Program – is the most effective
Exercise pyramid for Healthy life
Smoking cessation counselling
Pharmacological therapy  (Aspirin, clopidogril, pentoxfylline)
Stenting
Angioplasty
Autologous venous grafting
 
 

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Peripheral arterial occlusive disease