PATIENTS PERIPHERAL ARTERIAL DVT

DISEASE
RISK FACTORS
82 years old Male Highest prevalence of
atherosclerotic PAD occurs in
the 6th and 7th decades of life.
Occasional alcoholic Increased risk of developing
drinker PAD in cigarette smokers, and in
persons with diabetes mellitus,
hypercholesterolemia,
hypertension or renal
insufficiency
Coronary artery 1/3 to of patients with
Disease, Stable angina symptomatic PAD have
pectoris evidence of coronary artery
disease
RISK FACTORS
Gradual left leg patient with severe ischemia calf swelling and
swelling, 3 months develop peripheral edema aching, especially
because they keep their legs in a after prolong
dependent position much of the standing.
time superficial venous
thrombosis presents
with erythema,
tenderness, and a
palpable cord.
cramp or charley
horse in the lower
calf that persists and
intensifies over
several days
Intermittent Most common symptom is
claudication Intermittent claudication
Characterized by slow or
impaired gait;
Calf discomfort in aortoiliac
disease.
Transient relief from Diuretic and antibiotics are not
diuretics and part of the treatment
antibiotics
Left leg swelling
- pitting edema - pitting edema
- skin erythema - skin erythema (reactive
- several palpable hyperemia when leg is in
subcutaneous dependent position)
 nodules (largest: - subcutaneous nodules
2cm)
- minimal
tenderness

- Ulceration of the - Ulcers and gangrene -

left calf area may occur in critical limb
(included to sa ischemia
history but not in
the PE?)
- Weak (1) - important physical -
dorsalis pedis finding of PAD includes
pulse and decreased or absent
popliteal pulses pulses distal to
vs. right obstruction

Ddimer: .Slighly eleated An elevated D-dimer has been

associated with a lower ABI in
several cross-sectional studies
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901866/)

CT: Atherosclerosis is the leading

Atherosclerotic cause of PAD in patients >40
abdominal aorta, years old)
bilateral common iliac pathology of the lesions include
arteries atherosclerotic plaques with
calcium deposition primary
sites of involvement are the
abdominal aorta and iliac
arteries (30% of symptomatic
patients)
UTZ of the Heart: Again:
segmental wall motion 1/3 to of patients with
abnormality suggestive symptomatic PAD have
of CAD evidence of coronary artery
disease
ECG: The heart is the most common
source of
distal emboli, which accounts
for more than 90% of
peripheral
arterial embolic events. Atrial
fibrillation is the most common
source. pero iba to, pang
ATHEROEMBOLISM.
 Wells SCORE
Active cancer 1 0
Paralysis, paresis or 1 0
recent cast
Bedridden for >3days; 1 0
Major surgery <12 weeks
Tenderness along 1 1
distribution of deep veins
Entire leg swelling 1 1
Unilateral calf swelling 1 1
>3cm
Pitting edema 1 1
Collateral superficial 1 0
nonvaricose veins
Alternative diagnosis at -2 -2
least as likely as DVT

Patients Well scoring Score: 2 (patient has moderate likelihood to develop DVT)
Conclusion: DVT is less likely considered vs. PAD considering that the
characteristics of calf pain in patients with DVT is less consistent with that of the
patient, and that Wells Scoring did not indicate a high likelihood of DVT.

Peripheral Arterial Disease is a MORE PROBABLE diagnosis