Peripheral Artery Disease: The Daily PANCE Blueprint
A 72-year-old male with a history of hyperlipidemia and tobacco abuse presents to the clinic complaining of worsening crampy leg pain while walking. On the physical exam, you note shiny, pale lower extremities. There is a small ulcer on his left lateral malleolus. What is the most likely diagnosis?
A. Venous insufficiency
B. Diabetic neuropathy
C. Peripheral artery disease
D. Compartment syndrome
E. Deep vein thrombosis
Answer and topic summary
The answer is C. Peripheral artery disease
Peripheral arterial disease is defined by atherosclerotic occlusion of the peripheral arteries, most commonly in the lower extremities. Symptoms include intermittent claudication, atypical leg pain, and non-healing ulcers. On physical exam, you may see hair loss, pallor with leg elevation, dry skin, and ulcers (typically lateral malleolus). Risk factors include smoking, diabetes, obesity, hypertension, hyperlipidemia, and kidney disease. Diagnosis can be made by a resting ankle-brachial index (ABI) of <0.90. The definitive diagnosis is contrast arteriography. The pathophysiology is as follows: arterial narrowing from atherosclerosis leads to inadequate O2 delivery to the muscle during increased demand, causing claudication. Management includes smoking cessation, blood pressure control, high-intensity statin, supervised exercise therapy, and antiplatelet therapy with aspirin or clopidogrel (preferred) when there are no contraindications; however, support for aspirin monotherapy is weak.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the General Surgery PAEA EOR topic list
