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Lower Extremity Peripheral Artery Disease

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2 Key Points ➤ Lower extremity peripheral artery disease (PAD) is a common cardiovascular disease that is estimated to affect approximately 8.5 million Americans above the age of 40 years and is associated with significant morbidity, mortality, and quality of life (QoL) impairment. ➤ It has been estimated that 202 million people worldwide have PAD. Diagnosis Table 1.Definition of PAD Key Terms Term Definition Claudication Fatigue, discomfort, cramping, or pain of vascular origin in the muscles of the lower extremities that is consistently induced by exercise and consistently relieved by rest (within 10 min). Acute limb ischemia (ALI) Acute (<2 wk), severe hypoperfusion of the limb characterized by these features: pain, pallor, pulselessness, poikilothermia (cold), paresthesias, and paralysis. • One of these categories of ALI is assigned (ALI Section): I. Viable—Limb is not immediately threatened; no sensory loss; no muscle weakness; audible arterial and venous Doppler. II. Threatened—Mild-to-moderate sensory or motor loss; inaudible arterial Doppler; audible venous Doppler; may be further divided into IIa (marginally threatened) or IIb (immediately threatened). III. Irreversible—Major tissue loss or permanent nerve damage inevitable; profound sensory loss, anesthetic; profound muscle weakness or paralysis (rigor); inaudible arterial and venous Doppler. Tissue loss Type of tissue loss: • Minor—non-healing ulcer, focal gangrene with diffuse pedal ischemia. • Major—extending above transmetatarsal level; functional foot no longer salvageable.

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