Diabetes & Peripheral Arterial Disease:

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Relying on classic history ofclaudication alone can miss 85-90%ofdiagnosis 31/3 of patients do not report symptoms 1Do not associate claudication with arterial disease& increased mortalityDo not know symptoms & signs of PADVague description….fatigue, aching, numbnessAttribute to muscular pain, arthritis, or the non-specific musculoskeletal symptoms of aging 1,2Masked by inactivity1. Dormandy et al. J Vasc Surg. 2000; 31 (supp 1, pt 2): S1-S2962. Olin JW. www.svmb.org/medpro/cme/p1/cme_part1.html 20003. Hirsch et al. JAMA. 2001; 286: 1317-1324
Differential DiagnosisCALFVenous occlusion– Tight bursting pain / dullache that worsens onstanding and resolves withleg elevation– Positional pain reliefChronic compartmentsyndrome– Tight bursting pain– Positional pain reliefNerve root compression– Positional pain reliefBaker’s s cyst– Positional pain reliefHIP/THIGH/BUTTOCKArthritis– Persistent pain, brought on byvariable amounts of exercise– Associated symptoms in otherjointsSpinal cord compression– History of back pain– Symptoms while standing– Positional pain reliefFOOTArthritisBuerger disease(thromboangitis obliterans)Am J Cardiol 2001; 87 (suppl): 3D-13D
Page 1 and 2: Diabetes &Peripheral Arterial Disea
Page 3: Atherosclerosis is aSystemic Diseas
Page 6 and 7: PAD : Survival Curve1.000.75NormalS
Page 8 and 9: Impact on Quality of Life↓ Walkin
Page 10 and 11: Common Risk Factors for PAD*◄Less
Page 12 and 13: Prevalence of PAD in DMPAD is 20x m
Page 14 and 15: Tragic “Rule of 15”15% DM15% fo
Page 16 and 17: Problem with PAD isUnderdiagnosed &
Page 18 and 19: Clinical Presentations of PADClassi
Page 20 and 21: Critical Limb Ischaemia (CLI)Chroni
Page 24 and 25: • Colour• Deformities• Ulcer
Page 26 and 27: Are you at risk for Peripheral Arte
Page 28 and 29: Ankle Brachial Index (ABI)ABI =Lowe
Page 30 and 31: Interpretation of the ABIInterpreta
Page 33 and 34: Who should be screened with ABI?1.
Page 35 and 36: MRA & CTAPlanning forrevascularizat
Page 37 and 38: PAD Treatment GoalsImproveFunctiona
Page 39 and 40: Conservative TreatmentA- anti-plate
Page 41 and 42: Cilostazol (Pletaal)Antiplateletact
Page 43 and 44: Prevention of Amputation in DMRegul
Page 45 and 46: 60M, smoker, DM, lipid, CAD, CVA,bi
Page 47 and 48: Surgical Morbidity & MortalityWound
Page 49 and 50: Advantages of EndovascularTreatment
Page 51 and 52: Limb Salvage for CLIAvoid / Limit a
Page 53 and 54: Changing pattern ofrevascularizatio
Page 55: 74M, DM, Smoker, 1mth infected foot
Page 61 and 62: Ray amputation same admissionMeticu
Page 63 and 64: NO!
Page 65 and 66: SFA Compressive Forces: StentFractu
Page 67: “Fracture Resistant” SE Stents1
Page 70 and 71: Which Patients to Refer?Difficult D
Page 72 and 73:
Key RoleTake Home Massage:Role of G
Page 74:
Save a Leg . . . Save a LifeThank Y
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