Sean Tierney,
Consultant Vascular Surgeon
Adelaide & Meath National Children’s 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
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Presentation & differential diagnosisPresentation & differential diagnosis
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Presentation of atherosclerotic plaquePresentation of atherosclerotic plaque
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Peripheral Arterial Occlusive DiseasePeripheral Arterial Occlusive Disease
• Limitation on exercise (QOL)
• Risk of limb loss
• Global Health risk
Claudicants – concerns?
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PAOD PAOD secondary preventionsecondary prevention
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PAOD – PAOD – predictor of CVS diseasepredictor of CVS disease
Tasc; EJVS; 2000
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PAOD PAOD outcomeoutcome
Tasc; EJVS; 2000
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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
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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
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PAOD – PAOD – symptom reliefsymptom relief
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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment
Measures
• Stop smoking
• Exercise
• Drug therapy
• Surgery
approx doubling walking distance
approx doubling walking distance
?
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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment
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PAOD – PAOD – symptomaticsymptomatic treatmenttreatment
Endovascular Open surgery
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PAOD – PAOD – non-critical ischaemianon-critical ischaemia
surgery vs conservative treatment
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PAOD – PAOD – critical ischaemiacritical ischaemia
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PAOD – PAOD – limb salvagelimb salvage
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PAOD – PAOD – limb salvagelimb salvage
Peripheral angioplasty image
0
25
50
75
100
0 12 24 36
10 98
6 54
1No. at risk
Pop distal bypass
Kalbassi et al. IJMS 1999