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.

Boal arterial periferic (BAP)

cuprinde o serie de sindroame arteriale
non-coronariene
artere care deservesc creierul, organele
viscerale i membrele
Ateroscleroza (ATS)

Persoanele cu risc de BAP a

extremitilor inferioare
< 50 de ani + DZ + ali FR pentru ATS (fumat,
dislipidemie,HTA , sau hiperhomocysteinemia)

50 - 69 de ani + istoric de fumat sau de DZ

> 70 ani
Claudicaie membre inferioare sau durere
ischemic de repaus
Puls anormal la membrele inferioare
ATS coronarian, carotidian sau renal

Coprevalena
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 intit pentru tulburri de
mers, claudicaie, durere de repaus,
leziuni greu vindecabile (IC)
FR+ examinarea pulsului si inspecia
picioarelor (IC)

Investigaii

Indice glezna bra (IGB)

Ultrasonografie duplex / triplex
angioCT
angioRM
arteriografie

Investigaii
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
pacienii propui pentru revascularizare
(IB)

IGB
TA gamba / TA bra
Efectul Doppler

IGB
< 50 de ani + DZ + ali FR pentru ATS (fumat,
dislipidemie,HTA , sau hiperhomocysteinemia) (IC)
50 - 69 de ani + istoric de fumat sau de DZ (IC)
> 70 ani (IC)
Claudicaie membre inferioare sau durere
ischemic de repaus (IB)
Puls anormal la membrele inferioare (IC)
ATS coronarian, carotidian sau renal (IC)
Leziuni greu vindecabile (IC)

IGB
0.9 1.3
<0.9

Semnificaie
Normal, *
BAP (simptomatica sau
asimptomatica)

<0.7
<0.5

Claudicaie
Leziuni multiple seriate

<0.25
<0.2
>1.3

Durere in repaus
Ischemie / gangrena
Artere necompresibile
(BAP), **

*FR+ IGB dup efort ( >20% BAP)

** se msoar indicele haluce bra sau US duplex

IGB
Sn ~ 95%
Sp ~ 95%

Limite
FN:
leziuni izolate pe axele iliace sau pe aa.
femurale profunde
Pacieni 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