Periferna vaskularna bolest
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Peripheral Arterial Vascular
Disease in the Abdomen and Legs
RISK FACTORS
Older age (> 40 years)
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Male gender
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Smoking
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Diabetes mellitus
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Hyperlipidemia
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Hypertension
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Hyperhomocysteinemia
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When risk factors coexist, the risk increases several-fold
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Intermittent Claudication
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Discomfort (aching, cramping, tightness) is exercise-induced.
May involve one or both legs.
The onset is predictable and occurs at a constant walking
distance.
Relieved by standing still.
The discomfort usually occurs in the muscle group just distal
to the stenosis/occlusion.
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
WHAT CAUSES INTERMITTENT CLAUDICATION?
Atherosclerosis in peripheral arteries of legs
During exercise, oxygen demand increases
Muscles operate anaerobically
Produce lactic acid and other metabolites
Leg pain
Lactic acid and other metabolites washed away on rest
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WHY IS IT NECESSARY TO TREAT INTERMITTENT
CLAUDICATION ?
Symptoms worsen in 25% of patients
Approximately 5% will require amputation within 5 years
Around 5-10% have critical limb ischemia; risk of limb loss
Increased risk of mortality, primarily for cardiovascular
causes
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Peripheral Vascular Disease
The diagnosis is made clinically

Non-invasive testing (ABI’s with exercise and/or duplex
ultrasound) can confirm and quantify

Angiography is usually not needed for diagnosis and should be
reserved for patients undergoing planned treatment either with
endovascular or surgical therapy. It is also of value to diagnose
uncommon types of vascular disease.

Angiography will likely be replaced by CT/MRA for most
cases in the near future.
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
PRIMARY SITES OF
INVOLVEMENT
Femoral & Popliteal arteries: 8090%
Tibial & Peroneal arteries: 40-50%
Aorta & Iliac arteries: 30%
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
MANAGEMENT
Risk factor modification
Exercise therapy
Antiplatelet therapy
Medical therapy targeted at symptoms
Revascularisation procedures
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Uspešnost PTA
90%
30%
PTA ?
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
PTA ?
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
PTA AFS
Pre PTA
Posle PTA
PTA tehnike
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Graft
Autologous Vein Graft - SV, arm vein
Synthetic - PTFE, Decron
Graft failure
30 days - Technical error
30 days to 2 years - Intimal hyperplasia
>2 years - Progression of atheresclerosis
Surveillance
Duplex 6 wks peri-op, 3 months/2 yrs, q 6 month
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
The Most Important Intervention
STOP SMOKING !
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Renovascular Disease
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Renovascular Disease
Why Worry?
Poorly controlled hypertension

Progressive renal dysfunction
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Reduction of need for multiple meds
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No specific symptoms

Most common secondary cause of HTN
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Potentially correctable

Fibromuscular Dysplasia (FMD)
–
–
–
–
Unknown etiology
Second most common cause of RAS
Affects middle-aged women
More common in first-degree relatives and in the
presence of the ACE-I allele.
– Renal artery involvement is seen in 60% of cases frequently bilateral compromise.
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Fibromuskularna
hiperplazija
Renal Artery Stent Placement
Pre PTRA
Posle PTRA
Catheter- Based Interventions for RAS
I IIa IIb III
• Renal stent placement is indicated for
ostial atheroesclerosic RAS lesions that
meet the clinical crietria for intervention.
• Balloon angioplasty with “bail-out” stent
placement if necessary is recommended
for fibromuscular dysplasia lesions.
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Buerger’s
Disease
Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Buerger’s Disease
Recurrent superficial thrombophlebitis (“phlebitis migrans”)
Young adults, heavy smokers, no other atherosclerotic risk factors
Angiography - diffuse occlusion of distal extremity vessels
Progression - distal to proximal
Angiograski nalaz
Okluzije
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“izlged vadičepa”
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Oskudne kolaterale
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Dvosemestralna nastava za specijalizante radiologije KCCG, Medicinski fakultet UCG
Buerger’s Disease Thrombangiitis Obliterans
Exclusively associated with cigarette smoking
More prevalent in Middle East and Asia
Occlusive lesions seen in muscular arteries, with a predilection for
tibial vessels
Presentation - rest pain, gangrene and ulceration
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Interventna radiologija periferne vaskularne bolesti