Peripheral Artery Disease Research Paper Outline

Peripheral Vascular Disease

I. Definition of the disease
A. Peripheral Arterial Disease
1. Atherosclerotic:
a. Atheroma consisting of a core of cholesterol joined to proteins with a fibrous intravascular covering
i. Gradual progression ii. Segmental progression
2. Nonatherosclerotic:
a. Inflammatory and thrombotic process of arteries unrelated to atherosclerosis
i. Faster progression than atherosclerotic disease
II. Etiology/pathogenesis
A. Atherosclerotic
1. Risk factors
a. Age
b. Sex
c. Gender
i. Male
d. Environmental factors
i. Tobacco use

ii. Obesity
e. Underlying disease
i. Diabetes Mellitus ii. Hypertension iii. Dyslipidemia iv. Hyperhomocysteinemia
v. Coronary Artery Disease
f. Genetic Predisposition
Indicated for calcified vessel when the ABI cannot be applied diagnostically
B. Labs
1. Fasting Lipid profile
a. risk assessment of hyperlipidemia
2. Serum glucose
a. risk assessment of DM
3. Coagulation testing
a. risk assessment of hyperviscosity
4. CBC, BUN, creatinine and electrolytes
a. Risk assessment for factors that might lead to worsening peripheral perfusion
5. D-dimer, C-reactive protien, interleukin 6, and homocysteine
a. risk assessment of inflammatory process
6. ECG
a. risk assessment of dysrhythmia, chamber enlargement or MI
C. Imaging
1. Duplex ultrasonography and Doppler color-flow imaging for assessment of stenosed segments and lesion severity
a. Primary noninvasive study to determine flow status
2. MRA, coupled with 3D reconstruction for localization of occluded lesions
a. Highly sensitive and specific
b. Gold standard for diagnosis of PAD
VII. Medical management
A. Medication
1. Antiplatlets
a. Modify atherogenesis to help prevent complications from coronary syndromes and TIA’s
b. Lessen symptoms moderately
i. Aspirin ii. Aspirin and Dipyridamole iii. Clopidogrel iv. Ticlopidine
2. Phosphodiesterases
a. Symptom management
b. Adjunct to supervised physical therapy or