Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático
- claudicação intermitente
- dor na coxa ou nádegas ao andar, a qual é aliviada quando em repouso
- pulso reduzido ou ausente
- início súbito de dor intensa na perna acompanhada por dormência, fraqueza, palidez e perna fria
Other diagnostic factors
- disfunção erétil
- dor na perna em repouso
- gangrena
- feridas/úlceras que não cicatrizam
- atrofia muscular
- rubor dependente
- palidez quando a perna é elevada
- perda de pelos sobre o dorso do pé
- alterações no leito ungueal
- pele brilhante/descamativa
- membro pálido
- perda de nervo
Risk factors
- tabagismo
- diabetes
- hipertensão
- hiperlipidemia
- idade >40 anos
- história de doença arterial coronariana/doença cerebrovascular
- baixos níveis de exercício
- doença renal crônica (DRC)
- proteína C-reativa elevada
- hiper-homocisteinemia
- vasculite/condições inflamatórias
- fibrodisplasia arterial
Diagnostic tests
1st tests to order
- índice tornozelo-braquial (ITB)
Tests to consider
- índice hálux-braquial (IHB)
- exame da pressão segmentar
- registro de volume de pulso (RVP)
- ultrassonografia duplex
- ultrassonografia Doppler de ondas contínuas
- índice tornozelo-braquial (ITB) com exercícios
- angiografia por cateter
- angiotomografia
- angiografia por ressonância magnética (ARM)
Treatment algorithm
isquemia aguda de membro
claudicação (não limitante do estilo de vida)
claudicação (limitante do estilo de vida)
isquemia crônica com risco de perda do membro (CLTI)
Contributors
Authors
Leila Mureebe, MD, MPH, MMCi, FACS
Associate Professor of Surgery
Duke University Health Care
VA Mid Atlantic Healthcare System
Durham
NC
Disclosures
LM declares that she has no competing interests.
Acknowledgements
Dr Leila Mureebe would like to gratefully acknowledge Dr Ehrin Armstrong and Dr Kosmas I. Paraskevas, previous contributors to this topic.
Disclosures
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.
Peer reviewers
Khaled Ziada, MD
Assistant Professor
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Disclosures
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
Disclosures
DM declares that he has no competing interests.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Estenose da coluna vertebral
- Artrite
- Claudicação venosa
More DifferentialsGuidelines
- 2024 ESC guidelines for the management of peripheral arterial and aortic diseases
- 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease
More GuidelinesPatient information
Abandono do hábito de fumar
Doença arterial periférica
More Patient information
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