Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- 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
Outros fatores diagnósticos
- 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
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- ankle-brachial index (ABI)
Investigações a serem consideradas
- 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 tratamento
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
Declarações
LM declares that she has no competing interests.
Agradecimentos
Dr Leila Mureebe would like to gratefully acknowledge Dr Ehrin Armstrong and Dr Kosmas I. Paraskevas, previous contributors to this topic.
Declarações
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
Khaled Ziada, MD
Assistant Professor
Division of Cardiovascular Medicine
University of Kentucky
Lexington
KY
Declarações
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
Declarações
DM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
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 Resumo
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 Resumo
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 Resumo
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 Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Spinal stenosis
- Arthritis
- Venous claudication
Mais Diagnósticos diferenciaisDiretrizes
- 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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