Boala Arteriala Periferica – Elemente de Diagnostic Dr. Viorica Leanca
Boala Arteriala Periferica – Elemente de Diagnostic
Dr. Viorica Leanca
Classification of Recommendations
• I: Conditions for which there is evidence for and/or general agreement that a given procedure or treatment is beneficial, useful, and effective.
• II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.
• IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.• IIb: Usefulness/efficacy is less well established by evidence/opinion.
• III: Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful.
Level of Evidence• A: Data derived from multiple randomized
clinical trials or meta-analyses.• B: Data derived from a single randomized
trial or nonrandomized studies.• C: Only consensus opinion of experts,
case studies, or standard-of-care.
Boală arterială periferică (BAP)
• cuprinde o serie de sindroame arteriale non-coronariene
• artere care deservesc creierul, organele viscerale şi membrele
• Ateroscleroza (ATS)
Persoanele cu risc de BAP a extremităţilor inferioare
• < 50 de ani + DZ + alţi FR pentru ATS (fumat, dislipidemie,HTA , sau hiperhomocysteinemia)
• 50 - 69 de ani + istoric de fumat sau de DZ • > 70 ani • Claudicaţie membre inferioare sau durere
ischemică de repaus• Puls anormal la membrele inferioare• ATS coronariană, carotidiană sau renală
Coprevalenţa
• Risc de 2 – 6 x > de moarte prin eveniment coronarian
• Risc de 4 – 5 x > de AVC
Clasificarea Fontaine
• I - asimptomatic• IIa - claudicatie intermitenta la > 200 m• IIb - claudicatie intermitenta la < 200 m• III - durere de repaus / durere nocturna• IV - necroza / gangrena
Clinic
• FR+ interviu ţintit pentru tulburări de mers, claudicaţie, durere de repaus, leziuni greu vindecabile (IC)
• FR+ examinarea pulsului si inspecţia picioarelor (IC)
Investigaţii
• Indice glezna braţ (IGB)• Ultrasonografie duplex / triplex• angioCT• angioRM• arteriografie
Investigaţii
• Ultrasonografie duplex localizare si grad de stenoza (IA)
• angioCT prezenta si localizarea stenozelor importante (IIB)
• angioRM localizare si grad de stenoza (IA)
• Angiografia gold standard; indicata la pacienţii propuşi pentru revascularizare (IB)
IGB
• TA gamba / TA braţ• Efectul Doppler
IGB
• < 50 de ani + DZ + alţi FR pentru ATS (fumat,
dislipidemie,HTA , sau hiperhomocysteinemia) (IC)• 50 - 69 de ani + istoric de fumat sau de DZ (IC)• > 70 ani (IC)• Claudicaţie membre inferioare sau durere
ischemică de repaus (IB)• Puls anormal la membrele inferioare (IC)• ATS coronariană, carotidiană sau renală (IC)• Leziuni greu vindecabile (IC)
IGB Semnificaţie0.9 – 1.3 Normal, *<0.9 BAP (simptomatica sau
asimptomatica)<0.7 Claudicaţie<0.5 Leziuni multiple seriate<0.25 Durere in repaus<0.2 Ischemie / gangrena>1.3 Artere necompresibile
(BAP), ***FR+ IGB după efort ( >20% BAP)** se măsoară indicele haluce braţ sau US duplex
IGB
Sn ~ 95%Sp ~ 95%
Limite
FN:– leziuni izolate pe axele iliace sau pe aa.
femurale profunde– Pacienţi cu artere rigide
• ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation.
• Circulation 2006;113;e463-e465• http://circ.ahajournals.org