Peripheral arterial disease laboratory findings: Difference between revisions

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{{Peripheral arterial disease}}
{{Peripheral arterial disease}}


'''Editors-in-Chief: [[C. Michael Gibson]], M.D., Beth Israel Deaconess Medical Center, Boston, MA; [[User:Bobby Schwartz|Robert G. Schwartz, M.D.]] [mailto:RGSHEAL@aol.com], [http://www.piedmontpmr.com Piedmont Physical Medicine and Rehabilitation, P.A.]; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; [[User:Bobby Schwartz|Robert G. Schwartz, M.D.]] [mailto:RGSHEAL@aol.com], [http://www.piedmontpmr.com Piedmont Physical Medicine and Rehabilitation, P.A.]; '''Associate Editor-In-Chief:''' {{CZ}}


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==Overview==
==Laboratory Findings==
 
== Typical Noninvasive Vascular Laboratory Tests for Lower Extremity PAD Patients by Clinical Presentation - ACC/AHA Guidelines (DO NOT EDIT)==
 
<table border="1">
<table border="1">
<tr><td>'''Clinical presentation'''</td><td>'''Noninvasive vascular test'''</td></tr>
<tr><td>'''Clinical Presentation'''</td><td>'''Noninvasive Vascular Test'''</td></tr>
<tr><td>Asymptomatic lower extremity PAD</td><td>ABI</td></tr>
<tr><td>Asymptomatic lower extremity PAD</td><td>[[ABI]] (with stress studies for functional claudication)</td></tr>
<tr><td>[[Claudication]]</td><td>[[ABI]], PVR, or segmental pressures; Duplex ultrasound; Exercise test with ABI or assess functional status</td></tr>
<tr><td>[[Claudication]]</td><td>[[ABI]], PVR, or segmental pressures; Duplex ultrasound; Exercise test with ABI; [[PE]] to assess functional status</td></tr>
<tr><td>Possible pseudoclaudication</td><td>[[Exercise test]] with ABI</td></tr>
<tr><td>Possible pseudoclaudication</td><td>[[Exercise test]] with ABI; [[EMG]] and [[MRI]] for neurogenic etiologies</td></tr>
<tr><td>Possible sympathetic pain syndromes</td><td>[[Thermography]] (Sympathetic Skin Response Testing) for [[RSD]] and [[CRPS]]
<tr><td>Postoperative vein graft follow-up</td><td>[[Duplex ultrasound]]</td></tr>
<tr><td>Postoperative vein graft follow-up</td><td>[[Duplex ultrasound]]</td></tr>
<tr><td>Femoral pseudoaneurysm, iliac or popliteal aneurysm</td><td>Duplex ultrasound</td></tr>
<tr><td>Femoral pseudoaneurysm, iliac or popliteal aneurysm</td><td>[[Duplex ultrasound]]</td></tr>
<tr><td>Suspected aortic aneurysm; serial AAA follow-up</td><td>Abdominal ultrasound, CTA, or [[MRA]]</td></tr>
<tr><td>Suspected [[aortic aneurysm]]; serial [[AAA]] follow-up</td><td>Abdominal [[ultrasound]], CTA, or [[MRA]]</td></tr>
<tr><td>Candidate for revascularization</td><td>Duplex ultrasound, MRA, or CTA</td></tr>
<tr><td>Candidate for revascularization</td><td>[[Duplex ultrasound]], [[MR angiography]], or CTA</td></tr>
</table>
</table>
== Laboratory Findings ==
== 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)(DO NOT EDIT)<ref name="pmid21959305">{{cite journal |author= |title=2011 ACCF/AHA Focused Update of the Guideline for the Management of patients with peripheral artery disease (Updating the 2005 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines |journal=[[Circulation]] |volume=124 |issue=18 |pages=2020–45 |year=2011 |month=November |pmid=21959305 |doi=10.1161/CIR.0b013e31822e80c3 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21959305 |accessdate=2012-10-09}}</ref>==
=== Recommendations for Ankle-Brachial Index, Toe-Brachial Index, and Segmental Pressure Examination ===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The resting ABI should be used to establish the lower extremity PAD diagnosis in patients with suspected lower extremity PAD, defined as individuals with 1 or more of the following: exertional leg symptoms, nonhealing wounds, age 65 years and older, or 50 years and older with a history of smoking or diabetes.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The ABI should be measured in both legs in all new patients with PAD of any severity to confirm the diagnosis of lower extremity PAD and establish a baseline.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' The toe-brachial index should be used to establish the lower extremity PAD diagnosis in patients in whom lower extremity PAD is clinically suspected but in whom the ABI test is not reliable due to noncompressible vessels (usually patients with long-standing diabetes or advanced age). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Leg segmental pressure measurements are useful to establish the lower extremity PAD diagnosis when anatomic localization of lower extremity PAD is required to create a therapeutic plan. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' ABI results should be uniformly reported with noncompressible values defined as greater than 1.40, normal values 1.00 to 1.40, borderline 0.91 to 0.99, and abnormal 0.90 or less. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|}
=== Recommendations for Pulse Volume Recording ===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Pulse volume recordings are reasonable to establish the initial lower extremity PAD diagnosis, assess localization and severity, and follow the status of lower extremity revascularization procedures. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>
|}
=== Recommendations for Treadmill Exercise Testing With and Without ABI Assessments and 6-Minute Walk Test ===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Exercise treadmill tests are recommended to provide the most objective evidence of the magnitude of the functional limitation of claudication and to measure the response to therapy. (Level of Evidence: B)
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Astandardized exercise protocol (either fixed or graded) with a motorized treadmill should be used to ensure reproducibility of measurements of pain-free walking distance and maximal walking distance. (Level of Evidence: B)
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Exercise treadmill tests with measurement of preexercise and postexercise ABI values are recommended to provide diagnostic data useful in differentiating arterial claudication from nonarterial claudication (“pseudoclaudication”). (Level of Evidence: B)
|}


==References==
==References==

Latest revision as of 18:17, 4 October 2014

Peripheral arterial disease Microchapters

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Overview

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Differentiating Peripheral arterial disease from other Diseases

Epidemiology and Demographics

Risk Factors

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AHA/ACC Guidelines on Management of Lower Extremity PAD

Guidelines for Clinical Assessment of Lower Extremity PAD

Guidelines for Diagnostic Testing for suspected PAD

Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD

Guidelines for Medical Therapy for Lower Extremity PAD

Guidelines for Structured Exercise Therapy for Lower Extremity PAD

Guidelines for Minimizing Tissue Loss in Lower Extremity PAD

Guidelines for Revascularization of Claudication in Lower Extremity PAD

Guidelines for Management of CLI in Lower Extremity PAD

Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD

Guidelines for Longitudinal Follow-up for Lower Extremity PAD

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Robert G. Schwartz, M.D. [2], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

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Laboratory Findings

Clinical PresentationNoninvasive Vascular Test
Asymptomatic lower extremity PADABI (with stress studies for functional claudication)
ClaudicationABI, PVR, or segmental pressures; Duplex ultrasound; Exercise test with ABI; PE to assess functional status
Possible pseudoclaudicationExercise test with ABI; EMG and MRI for neurogenic etiologies
Possible sympathetic pain syndromesThermography (Sympathetic Skin Response Testing) for RSD and CRPS
Postoperative vein graft follow-upDuplex ultrasound
Femoral pseudoaneurysm, iliac or popliteal aneurysmDuplex ultrasound
Suspected aortic aneurysm; serial AAA follow-upAbdominal ultrasound, CTA, or MRA
Candidate for revascularizationDuplex ultrasound, MR angiography, or CTA

References


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