Penyakit Pembuluh Darah Perifer-2013 PDF
Penyakit Pembuluh Darah Perifer-2013 PDF
PERIFER
Erlina Marfianti
Dept IPD FK UII
Tujuan Pembelajaran
• Menjelaskan pathogenesis gangguan vaskuler
perifer
• Menjelaskan factor risiko gangguan vaskuler
perifer
• Menjelaskan manifestasi klinis gangguan
gangguan vaskuler perifer
• Menjelaskan pemeriksaan fisik dan penunjang
gangguan vaskuler perifer
• Menyebutkan penyakit akibat gangguan
vaskuler perifer
SPECTRUM
PVD
Arteri Vena
Pembuluh
limfe
Penyebab
Ischemic Heart
Disease
Cerebrovascular
Disease
Peripheral Vascula
Infarcti
Disease
MI
Coronary
Death
Effort Angina
Stroke
Clinically Silent Claudication
Critical Leg
Ischemia
Increasing Age
Courtesy of P Ganz.
EPIDEMIOLOGI
• Terdapat 1 dari 20 orang di atas usia 50, atau 8 juta
orang di Amerika Serikat.
• The prevalence: >55 years is 10%–25%
• 70%–80% of affected individuals are asymptomatic
• PVD hanya didiagnosis pada 50% dari populasi.
• PVD gejala membawa setidaknya risiko 30%
kematian dalam waktu 5 tahun dan hampir 50%
dalam waktu 10 tahun, terutama disebabkan MI
(60%) atau stroke (12%).
Factor risiko
• Umur
• Laki-laki
• Hyperlipidemia
• Kegemukan
• Resistensi insulin
• Diabetic Mellitus
• Tobacco
• Hipertensi dan hiperkolesterol
• Sedentary life
• Riwayat keluarga
Faktor pemberat
• Infection
• Pressure (impaired sensation)
• Hematological diseases
• Neoplastic diseases
Risk Factors:
Typical Patient:
• Smoker (2.5-3x)
• Diabetic (3-4x)
• Hypertension
• Hx of Hypercholesterolemia/AF/IHD/CVA
• Age ≥ 70 years.
• Age 40 - 49 with diabetes and at least one other risk factor for
atherosclerosis.
2. Other Symptom/Signs:
• A burning or aching pain in the feet (especially at night)
• Cold skin/feet
• Increased occurrence of infection
• Non-healing Ulcers
• Asymptomatic
Pulselessness
Paralysis
Paraesthesia
Pain
Pallor
Gejala Penyakit arteri perifer
• Pulselessness, mati rasa, atau sianosis.
• Kelumpuhan dapat mengikuti,
• dan ekstremitas dapat menjadi dingin,
• sering dapat terjadi gangrene.
• Sukarnya penyembuhan luka atau borok di
ekstremitas membantu memberikan bukti sudah
ada sebelumnya PVD.
30% Buttock & Hip Claudication
±Impotence – Leriche’s Syndrome
Thigh Claudication
Foot Claudication
DDx of Leg Pain
1. Vascular
a) DVT (as for risk factors)
b) PVD (claudication)
2. Neurospinal
a) Disc Disease
b) Spinal Stenosis (Pseudoclaudication)
3. Neuropathic
a) Diabetes
b) Chronic EtOH abuse
4. Musculoskeletal
a) OA (variation with weather + time of day)
b) Chronic compartment syndrome
Pemeriksaan fisik
• Tanda klasik 5 P
• Didasarkan anamnesis : nyeri
• Kulit
▫ Color- rubor, pallor, cyanosis, ecchymosis
▫ Hair, nails
▫ Lesions- ulcers, gangrene
• Tonus otot: gait, posture
• Abdomen: shape, scars, pulsitile
• Extremitas: how many, length, size
Pemeriksaan fisik
• Skin
▫ Temperature
▫ Texture
• Abdomen
▫ Tenderness
▫ Mass, Pulsitile?
• Pulse Exam
▫ Top-to-Bottom
▫ Bilateral
▫ Thrills
Pemeriksaan fisik
• Pulseless
• Pallor
• Paresthesi
• Dingin
• Ulcer
• Bruits
▫ Cervical, Supraclavicular, Infraclavicular,
Abdominal, Femoral
Physical Examination:
Examination: What do to:
<0.15 Gangrene
CAUTION:
Patient’s with Diabetes + Renal Failure:
They have calcified arterial walls which can falsely elevate their ABI.
ABI
• Ankle-brakialis Indeks Test (ABI)
▫ Tekanan darah pada lengan dan pergelangan kaki
diperiksa menggunakan tekanan darah manset
reguler dan stetoskop USG khusus yang disebut
Doppler.
▫ Tekanan di pergelangan kaki Anda dibandingkan
dengan tekanan di lengan Anda untuk
menentukan seberapa baik darah mengalir.
▫ Indeks ini dihitung dengan membagi pergelangan
tekanan darah sistolik lengan tekanan darah
sistolik.
Measurement of the Ankle–Brachial Index (ABI)
Right-arm Left-arm
systolic pressure systolic pressure
DP DP Left-ankle
Right-ankle
systolic pressure systolic pressure
PT PT
Non-invasive:
• CT Angiogram
• MR Angiogram
Invasive:
• Digital Subtraction Angiography
Gold Standard
Intervention at the same time
Tardus et parvus = small amplitude + slow rising pulse
CT Angiography Digital
Subtraction Angiography
Value of angiography
Localizes the obstruction
Visualize the arterial tree & distal
run-off
Can diagnose an embolus:
Sharp cutoff, reversed meniscus or clot
silhouette
Yang sering
• Vascular
Arterial
Aneurisme
• Penyakit arteri oklusi perifer (PAPO)
• Thromboangiitis obliterans
(Buerger disease)
•
Venous
Varises
• Phlebitis
• Deep Vein trombosis (DVT)
Penyakit arteri perifer oklusi (PAPO)
• Penyakit aterosklerosis seringnya melibatkan
lengan hampir selalu terbatas pada pembuluh
proksimal besar dan jarang melibatkan, arteri
brakialis radial, atau ulnaris.
• Meskipun pasien tidak memiliki gejala, mereka
dapat memiliki perbedaan besar di antara BP
lengan kiri dan kanan.
• mengukur BP di kedua lengan.
Chronic Occlusive Arterial Diseases
Differential Diagnosis
Atherosclerosis Thromboangiitis
Artery large small
Course slow rapid
Symptoms less severe more severe
Claudication calf, thigh, hip foot, arch
Arm usually not often
Phlebitis not may involve
Revascularization possible not
Amputation may occur often occur
Associated CAD often not
Death from MI often rare
Gejala dan tanda
Chronic Occlusive Arterial Diseases
• Claudication
• Ischemia
Resting pain
Ischemic neuropathy
Ulcerations
Gangrene
• Microcirculatory lesions
• Impotency
Prevalence of Peripheral Arterial Disease, Claudication
and Associated Cardiovascular Diseases
Renovascular disease
Intestinal Ischemia
Erectile dysfunction