PAD

6 "P"s - Pale, Pulsess, Painful, Perishingly cold, >> not reliable

Paraesthetic and Paralysis >> impending irreversible ischemia

Risk factors

HTN, Hypercholesterolemia and Smoking

Dx

Workup starts from least invasive with ankle-brachial indices and pulse venous recordings (Doppler U/S of the flow at each arterial level) to more invasive with imaging with peripheral contrast to local contrast injection with direct angiography

ABPI should close to 1.0, claudication starts when < 0.7; rest pain if <0.4

An ABI >1.3 indicates vascular calcification/ rigid arteries;

Management

A. Conservative management = best initial therapy

• Smoking cessation!
• Supervised graded exercise therapy
• Foot care (especially in diabetic patients)
• Avoid cold temperatures

B. Medical therapy

ASA, and cilostazol (single most effective medication) PDE-3 inhibitor

If failed,