Lecture on Peripheral Arterial Disease (PAD)

Introduction

• Topic: Lorex Germany arterial disease diagnosis by non-invasive techniques and the role of podiatrists.
• Structure: Part one out of two parts.

Natural History of PAD

• Definition: PAD is a manifestation of generalized atherosclerotic disease affecting leg circulation.
• Prevalence: Up to 20% of patients older than 60 years old.
• Presentation Spectrum: Ranges from asymptomatic to limb and life-threatening disease.
• Link with Cardiovascular Disease: Often missed; 25% of PAD patients die from cardiovascular causes.

Mortality and Morbidity

• Studies: Armstrong et al. (2007 & 2020 update): High 5-year mortality rates for patients with diabetic foot ulcers compared to certain cancers.
• Context: Over 50% of patients with major limb amputation die within 5 years.

Risk Factors

• Framingham Heart Study: Hypertension and hyperlipidemia as independent risk factors for PAD.
  • Blood pressure > 160/95 mmHg: Increased risk of intermittent claudication.
  • Fasting cholesterol > 7 mmol/L: Doubled risk of claudication.

PAD and Cardiovascular Disease

• ABPI: Ankle Brachial Pressure Index < 0.9 linked with twice the cardiovascular mortality risk.
• Critical Limb Ischemia: Severe PAD associated with very high cardiovascular risk.

Type 2 Diabetes and PAD

• Metabolic Syndrome: Includes obesity, hypertension, hyperlipidemia, increased coagulability.
• Stroke Risk: Type 2 diabetes increases risk by 150% to 400%.
• Gender Differences: Women with T2D may have higher coronary artery disease risk than men.
• Glycemic Control: 1% increase in HbA1c linked with 26% increased risk of developing PAD.

Rheumatological Conditions and PAD

• Increased Risk: Rheumatoid arthritis patients have higher prevalence of vascular disease.
• Steroid Usage: Potential risk factor.

Underdiagnosis and Undertreatment

• Evidence: Half of PAD patients have atypical pain, leading to delayed diagnosis and incorrect referrals.
• Misleading Treatments: Celebrity-endorsed, non-evidence-based products delaying actual medical intervention.

Management of PAD

• First Line Treatment: Optimize modifiable cardiovascular risk factors.
  • Smoking cessation, cardiovascular medicine, supervised exercise programs.

National Guidelines

• Scotland vs. England: Use of SIGN 89, SIGN 149 in Scotland & NICE CG 147, CG 181 in England.
• Implementation: Local care pathways based on these guidelines for better management.
• Examples: Integrated care pathways from acute hospitals and diabetes UK for lower limb amputation prevention.

Role of Podiatrists

• Survey (2018): Majority of vascular assessments by UK podiatrists inconsistent with international guidelines.
• Confidence Levels: Podiatrists need more education for managing cardiovascular risks in PAD patients.

Final Thoughts

• Self-Assessment: Evaluate personal learning needs on diagnosing, referring, and managing PAD, understanding cardiovascular risk management strategies, and using diagnostic techniques.

Conclusion

• Next Session: Part two will follow up on this lecture.