peripheral vascular disease 2015

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  • Sean Tierney,Consultant Vascular Surgeon

    Adelaide & Meath National Childrens Hospital,Tallaght

  • http://www.perfuse.netVascular surgery @ Tallaght

    Issues in PAODIssues in PAOD

    Presentation and differential diagnosis

    Assessment/management of cardiovascular risk

    Managing symptoms Prevention of limb loss

  • http://www.perfuse.netVascular surgery @ Tallaght

    Presentation & differential diagnosisPresentation & differential diagnosis

  • http://www.perfuse.netVascular surgery @ Tallaght

    Presentation of atherosclerotic plaquePresentation of atherosclerotic plaque

  • http://www.perfuse.netVascular surgery @ Tallaght

    Peripheral Arterial Occlusive DiseasePeripheral Arterial Occlusive Disease

    Limitation on exercise (QOL)

    Risk of limb loss

    Global Health risk

    Claudicants concerns?

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD secondary preventionsecondary prevention

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD predictor of CVS diseasepredictor of CVS disease

    Tasc; EJVS; 2000

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD outcomeoutcome

    Tasc; EJVS; 2000

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD Real risksReal risks

    Limitation on exercise (QOL)

    Risk of limb loss

    Global Health risk

    Patients Concerns

    Death from MI/CVA

    Limitation on exercise

    Risk of limb loss

    Relative risk

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD Tx PAOD Tx reduce global risk reduce global risk

    Measures

    Stop smoking Optimum therapy underlying disease

    (DM, HTN, etc.) Antiplatelet (? Clopidogrel) CAPRIE Statin (? even if normal XOL) ASCOT

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD symptom reliefsymptom relief

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD symptomaticsymptomatic treatmenttreatment

    Measures

    Stop smoking

    Exercise

    Drug therapy

    Surgery

    approx doubling walking distance

    approx doubling walking distance

    ?

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD symptomaticsymptomatic treatmenttreatment

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD symptomaticsymptomatic treatmenttreatment

    Endovascular Open surgery

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD non-critical ischaemianon-critical ischaemia

    surgery vs conservative treatment

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD critical ischaemiacritical ischaemia

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD limb salvagelimb salvage

  • http://www.perfuse.netVascular surgery @ Tallaght

    PAOD PAOD limb salvagelimb salvage

    Peripheral angioplasty image

    0

    25

    50

    75

    100

    0 12 24 36

    10 98

    6 54

    1 No. at risk

    Pop distal bypass

    Kalbassi et al. IJMS 1999

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