Core IM | Internal Medicine Podcast #165 Peripheral Arterial Disease: 5 Pearls Segment
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Nov 27, 2024 Arthi Rao, a cardiology fellow, and Eric Sosemsky, a vascular medicine cardiologist, dive deep into the complexities of peripheral arterial disease (PAD). They discuss when to suspect PAD and the critical role of the Ankle-Brachial Index (ABI) in diagnosis. The conversation highlights non-surgical management strategies, emphasizing lifestyle changes, medications like cilostazol, and cardiovascular risk management. They also outline when revascularization may be necessary and explore therapy options that can significantly improve patient quality of life.
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Atypical PAD Presentations
- Only 10% of PAD patients experience classic claudication (leg pain with exercise, relieved by rest).
- 50% have atypical symptoms like leg heaviness, tingling, or no leg symptoms at all.
Suspecting PAD
- Suspect PAD in patients over 65, smokers, or with diabetes, kidney disease, or hypertension who have lower extremity symptoms.
- Ask how pain is relieved and how long it takes, to differentiate PAD from mimics like spinal stenosis or venous insufficiency.
Buttock Claudication
- A patient presented with hip and buttock pain, initially diagnosed as arthritis.
- Further testing revealed severe aortoiliac disease causing buttock claudication, highlighting the importance of considering PAD in atypical presentations.