Peripheral arterial disease
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- asymptomatic
- intermittent claudication
- thigh or buttock pain with walking that is relieved with rest
- diminished or absent pulse
- sudden onset of severe leg pain accompanied by numbness, weakness, pale and cold leg
Otros factores de diagnóstico
- erectile dysfunction
- leg pain at rest
- gangrene
- nonhealing wound/ulcer
- muscle atrophy
- dependent rubor
- pallor when the leg is elevated
- loss of hair over the dorsum of the foot
- nail bed changes
- shiny/scaly skin
- pale extremity
- nerve loss
Factores de riesgo
- smoking
- diabetes
- hypertension
- hyperlipidemia
- age >40 years
- history of coronary artery disease/cerebrovascular disease
- low levels of exercise
- chronic kidney disease (CKD)
- elevated C-reactive protein (CRP)
- hyperhomocysteinemia
- vasculitis/inflammatory conditions
- arterial fibrodysplasia
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- ankle-brachial index (ABI)
Pruebas diagnósticas que deben considerarse
- toe-brachial index (TBI)
- segmental pressure examination
- pulse volume recording
- duplex ultrasound
- continuous wave Doppler ultrasound
- exercise ankle-brachial index (ABI)
- catheter angiography
- CT angiogram
- magnetic resonance angiography (MRA)
Algoritmo de tratamiento
acute limb ischemia
claudication (not lifestyle-limiting)
claudication (lifestyle-limiting)
chronic limb-threatening ischemia (CLTI)
Colaboradores
Autores
Leila Mureebe, MD, MPH, MMCi, FACS
Associate Professor of Surgery
Duke University Health Care
VA Mid Atlantic Healthcare System
Durham
NC
Divulgaciones
LM declares that she has no competing interests.
Agradecimientos
Dr Leila Mureebe would like to gratefully acknowledge Dr Ehrin Armstrong and Dr Kosmas I. Paraskevas, previous contributors to this topic.
Divulgaciones
EA is an advisory board member for Abbott Vascular, Boston Scientific, Medtronic, and Philips. EA and KIP are both authors of references cited in this topic.
Revisores por pares
Khaled Ziada, MD
Assistant Professor
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Divulgaciones
KZ declares that he has no competing interests.
Debabrata Mukherjee, MD
Gill Foundation Professor of Interventional Cardiology
Director of Cardiac Catheterization Laboratories
Gill Heart Institute
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Divulgaciones
DM declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024 Sep 29;45(36):3538-700.Texto completo Resumen
Writing Committee Members; Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2024 Jun 18;83(24):2497-604.Texto completo Resumen
Norgren L, Hiatt WR, Dormandy JA, et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5-67.Texto completo Resumen
Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34;e1-2.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Spinal stenosis
- Arthritis
- Venous claudication
Más DiferencialesGuías de práctica clínica
- 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease
- 2024 ESC guidelines for the management of peripheral arterial and aortic diseases
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