Cardiology overview peripheral arterial disease

Cardiology Overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Ankle Brachial Index (ABI)

The ABI is a screening test for the assessment for the presence of PAD.

• Ratio of the ankle blood pressure divided by the highest brachial blood pressure
• Normal is 0.9 to 1.3
• The exercise ABI is done by having the patient stand on their toes repeatedly as exercies. The ABI is rechecked after exercise. This test is done if the patient has symptoms with exercise and a normal ABI at rest.

Carotid Endarterectomy (CEA) vs Stenting

• The CREST study showed a higher rate of death/MI in patients treated with stenting vs CEA: 6.4% vs 4.7%
• CEA is preferred in patients who impaired renal function who are at risk of contrast induced nephropathy, tortuous calcified aortoas, complex eccentric calcified lesions
• Stenting may be preferred in patients with high carotid bifurcations where it is hard for surgeons to technically perform the surgery
• If an elderly patient has a transient ischemic attack and if there is a narrowing in the ipsilateral artery, then carotid endarterectomy should be performed within two weeks of the symptoms.

Aortic Dissection

• Surgical repair (not endovascular repair) is indicated in patients with a type A aortic dissection
• An aortic root diameter > 5.5 cm is an indication for surgery

Renal Artery Stenosis

• Magnetic resonance angiography is the most sensitive modality to make this diagnosis, ultrasound is somewhat insensitive.