Peripheral Artery Disease (PAD)

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PAD

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Peripheral artery disease
-DDx includes: DVT vs superficial thrombophlebitis vs critical limb ischemia.
-PAD due to reduced pulse, claudication, hair loss in limb and presence of risk factors.
-Obtain ABI (normal 0.9-1.3).
-Obtain CBC, BMP, CRP, Ddimer. 
-Lower extremity doppler. 
-Continue high intensity statin therapy + Aspirin or Plavix.
-Walking therapy 3 times per week, for 12 weeks: walk until painful, then rest, and keep walking for 1 hour.
-Education provided on lifestyle modification, encouraged to quit smoking, lowering cholesterol, controlling hypertension and diabetes, and maintaining healthy weight. 
-BP goal of <130/80.
-Cilostazol in patients without CHF.
-Consider Pentoxifylline, if no benefit with Cilostazol in 12 weeks.
-Monitor for critical limb ischemia.
-Balloon angioplasty or stent placement for refractory cases. Will refer/consult vascular surgeon/IR. May want an MRA or CT angio.
-May require bypass grafts, surgery consult or referral. 
-Monitor for ischemia/gangrene, amputation, erectile dysfunction, CAD and CVA.