Changes consistent with peripheral vascular insufficiency are found on an examination for complaints of calf pain on walking more than half a block. Distal pulses are absent, and the ankle-brachial index on the right is 0.5. conservative management rather than reconstructive arterial surgery is generally recommended for patients with which of the following symptoms or signs of arterial insufficiency?
|D||Nocturnal foot pain|
a. The presence of PAD can most accurately be determined by measurement of the ankle-brachial index. An ABI of less than 0.9 is considered to be diagnostic of PAD and is associated with a 50% or greater risk for vessel stenosis.
b. The risk of critical limb ischemia in patients with claudication is relatively low, about 1% per year, but the risk of death from coronary and cerebrovascular events is much higher, about 5 to 10% per year.
c. The cornerstone of medical management is reduction of vascular risk factors such as smoking cessation, control of blood pressure, reduction of blood lipid levels including statin therapy, correction of elevated homocysteine levels, and compression stockings
d. Drugs include the statins for LDL reduction, ACE inhibitors to treat blood pressure, and beta blockers for their cardioprotective effects. In addition, all patients should be given a trial of cilostazol, clopidogrel, or aspirin.