(Peripheral Vascular Disease)

Peripheral arterial occlusive disease (PAOD), atherosclerosis of extremities is caused (almost always of the lower extremities), the Ischiämie. A slight PAD may be asymptomatic or cause intermittent claudication; a severe PAD can lead to pain at rest with skin atrophy, hair loss, cyanosis, ischemic ulcers and gangrene. Diagnosis is based on history, physical examination and measurement of ankle-brachial index. The treatment of mild PAD includes the modification of risk factors, training, platelet inhibitors, cilostazol or possibly pentoxifylline as needed for symptoms. The severe PAD usually requires an angioplasty or bypass surgery and may even require amputation. The prognosis is generally good with treatment, although the mortality rate is relatively high because of CHD or cerebrovascular diseases often present simultaneously.

Peripheral arterial occlusive disease (PAOD), atherosclerosis of extremities is caused (almost always of the lower extremities), the Ischiämie. A slight PAD may be asymptomatic or cause intermittent claudication; a severe PAD can lead to pain at rest with skin atrophy, hair loss, cyanosis, ischemic ulcers and gangrene. Diagnosis is based on history, physical examination and measurement of ankle-brachial index. The treatment of mild PAD includes the modification of risk factors, training, platelet inhibitors, cilostazol or possibly pentoxifylline as needed for symptoms. The severe PAD usually requires an angioplasty or bypass surgery and may even require amputation. The prognosis is generally good with treatment, although the mortality rate is relatively high because of CHD or cerebrovascular diseases often present simultaneously. Etiology The prevalence of PAD is about 12% in the US .; Men are more commonly affected. The risk factors are similar to those of arteriosclerosis: older age, hypertension, diabetes, dyslipidemia (high LDL cholesterol, low HDL cholesterol), cigarette smoking (including passive smoking.) And other forms of tobacco use and a family history of atherosclerosis. Obesity, male gender and high homocysteine ??levels are further risk factors. Atherosclerosis is a system disease, 50-75% of patients with PAD also have a clinically significant CAD and cerebrovascular diseases. However, the CHD can silently run, as the PAD, the patient partially deter incriminate himself enough to trigger an angina. Typically, symptoms and complaints calls the PAD claudication out claudication. This is a painful, burning, unpleasant or exhausted feeling in the legs that occurs during walking and subsides with rest. The claudication usually occurs in the lower legs, but can also in the feet, thighs, hips, buttock or rarely occur in the arms. The claudication is an expression of stress-induced reversible ischemia similar to angina. If the PAD progresses, the distance that can be covered without symptoms may decrease and patients with severe PAD may experience a pain at rest, which reflects an irreversible ischemia. The rest pain is usually more distal stronger and is further enhanced by leg Elevating (which often causes pain in the night) and decreases when the leg below the level of the heart is. The pain may be burning, exciting or drawing, although this finding is not specific. About 20% of patients with PAD are asymptomatic, sometimes because they are not active enough to trigger the leg ischaemia. Some patients have atypical symptoms (eg. As a non-specific exercise intolerance, hip or other joint pain). A slight PAD often causes no clinical findings. Moderate or severe PAD usually causes decreased or absent peripheral (popliteal artery, posterior tibial artery, dorsalis pedis artery) pulses; a Doppler ultrasound can detect blood flow often when the pulses can not be palpated. If the foot is below the level of the heart, it can appear dark (called dependent redness). In some patients, the lifting of the foot leads to a loss of color and enhances the pain; when the foot is lowered, the venous filling is extended (> 15 seconds). Edema is usually not present unless the patient has not moved his foot and left in a hanging position, so that the pain subsides. Patients with chronic PAD can be thin, pale (atrophic) identify skin with hair thinning or hair loss. The distal legs and feet may feel cold, the affected leg may sweat excessively and cyanotic, probably due to over-activity of the sympathetic nervous system. Cyanosis (peripheral arterial occlusive disease) DR P. MARAZZI / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/ – / media / manual / professional / images / m1750188-cyanosis-peripheral-vascular-disease-science-photo-library-high_de. jpg lang = en & thn = 0 & mw = 350? ‘, imageUrl:’ /-/media/manual/professional/images/m1750188-cyanosis-peripheral-vascular-disease-science-photo-library-high_de.jpg?la=de&thn=0 ‘title’ cyanosis (peripheral arterial disease), ‘description’ u003Ca id = “v37893786 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDie fourth toe is white and cold in this patient with peripheral arterial occlusive disease u003c / p u003e u003c / div u003e ‘credits’. DR P. MARAZZI / SCIENCE PHOTO LIBRARY’

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