A 60 year old male diabetic presented with resting limb pain for last 3 days

A 60 year old male diabetic presented with resting limb pain for last 3 days. He has history of intermittent claudication for last 4 years and was compliant to his medications and regular exercise. On examination he has elevation limb pallor with decrease capillary refill on attaining supine position. No skin discoloration and pulses are week but palpable. One year ago his pre and post exercise ABI was 0.6. He is currently on ASA 75mg OD, atorvastatin 10mg HS, cilostazole 100mg BD and Metformin 1G BD. Please provide relevant answers:

a) What was the purpose of giving ASA and Cilostazole

b) His Digital extraction angiography showed critical disease in superficial femoral artery and popliteal artery. When will you consider him for revascularization and what modality will you choose?

c) When will you follow your patient after successful revascularization?

d) What non-invasive test will you order apart from history and physical examination in surveillance program?

Answers:

a)      ASA is indicated for purpose of risk reduction( reducing risk of MI, Stroke and vascular death) in individual with symptomatic PAD and cilostazole is given for symptom relief and improving walking distance

b)      Considered for revascularization when lifestyle limiting claudication occur despite of OMT(Pharmacotherapy) and exercise, non healing ulcer, anatomy suitable for revascularization with acceptable per procedural risk.

c)      After 3, 6 and 12 months then annually

d)      Exercise ABI and Duplex USG (Class I)

Reference:

1. 2013 Guidelines for management of PAD

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