Peripheral Arterial Occlusive Disease
Acute PAOD:
1. Etiology - Embolus (majority), thrombus, or trauma
2. 症狀 - 6Ps (pain, paralysis, paresthesia, pallor, pulselessness, poikilothermy)
3. Thrombosis vs. Embolism
|
Thrombosis |
Embolism |
|
Previous claudication |
No previous symptoms of arterial insufficiency (無足夠時間形成側枝循環) |
|
No source of emboli |
Obvious sources of emboli(AF、MI) |
|
Long history |
Sudden onset |
|
Less severe ischemia |
Severe ischemia |
|
Lack of pulses in the contralateral leg |
Normal pulses in the contralateral leg |
|
Positive signs of chronic ischemia |
No signs of chronic ischemia |
4.diagnosis- history+PE, arteriography
-many patient have coexistent cardiac disease: ECG, CXR, and TEE
5.management-heparin(administered immediately)
- 早發現 (數小時內) - thrombolytic therapy
- 晚發現 (>一天) - surgical embolectomy
6.complication-reperfusion injury, rhabdomyolysis, compartment syndrome
Chronic PAOD:
1.Etiology - Atherosclerosis (majority)
2.diagnosis- lower-extremity symptoms: pulses, bruits, ulcers
-ABI:normal>1.0, claudication<0.8, rest pain and severe ischemia<0.4
-digital subtraction arteriography (gold standard)
<p.s>ulcer classification:
A
V
Neuropathy :Skin calloused, No pain, Usually no gangrene, Decreased sensation, abscent ankle jerks
3.Classification:
Fontaine Classification:
Stage 1 - Numbness (Asymptomatic)
Stage 2 - Intermittent claudication
Stage 3 - Ischemic rest pain
Stage 4 - Ulceration or gangrene
Dry gangrene:預後較好，會auto-amputation
Wet gangrene:預後較差，會infection，要用抗生素
3及4的症狀又稱為肢體危急性缺血症狀(critical limb ischemia)此時需要手術介入
4.management - physical : 睡覺時把腳放低於心臟的位置, 多運動
- Medication: lipid reduction, antihypertensives, aspirin, and antiplatelet drug
- Surgical : stenting, amputation
留言列表
