NOVEMBER 14 | MONDAY 2011

Peripheral Artery Occlusion Disease, PAOD

Speaker
1

Fluid Dynamics
2
Fig. 1
dr
A,
F
Fig. 2
gradient of velocity
fluids of viscosity the
contact of area the
force
stress shear
;
=
=
=
=
=
= =
dr
dv
A
F
S
dr
dv
S
A
F
S
q
q
P
1
L P
2
R
r
1
v
1
(r
1
)
v
2
(r
2
)
x r
r
2
< =

=
= =
) 0 ( ; 0 ) (
: conditions Boundary
2
) (
0
: flow developed fully For
2 1
v R v
L
P P r
dr
dv
F F F
visc p a
q
) (
4
) (
: profile velocity parabolic The
2 2
2 1
r R
L
P P
r v

=
q
) (
: force pressure The
2
: force viscous The
2 1
2
P P r F
dr
dv
rL S A F
dr
dv
A
F
S
p
visc
visc
=
= =
= =
t
q t
q
) (
4
) (
2 2 2 1
r R
L
P P
r v

=
q
P
1
P
2
L
r

dr
R 0
Q
}

= =
R
L
P P R
rdr r v Q
0
2 1
4
8
) (
2 ) (
q
t
t
2 4
2 1
;
8
R
Q
v
R
L
Q
P P
R
p
t t
q
= =

=

tube the of Length
viscosity Fluid
gradient Pressure
tube the of Radius
Flow
2 1
=
=
=
=
=
L
P P
R
Q
q
S
h
e
a
r

s
t
r
e
s
s
,

S

Shear rate or deformation rate,
r
v
c
c
Newtonian fluid
(air, water, and oil)
q
Fig. 3
Fig. 4
r
L
P P
dr
dv
r R
L
P P
v
q q 2
) (
4
2 1
2 2
2 1

=

=
3 3
4

4 4
R
Q
dr
dv
S
R
Q
R
v
dr
dv
R r
R r
R r
t
q
q
t
= = = =
=
=

=
3
Viscosity and Blood Flow
Fig. 5
0
0
=
= r
dr
dv
3
4
R
Q
S
s
t
q
t = =
t
s
S
R
Shear Stress Exerted by the Fluid on the Tube Wall
L
P P R
R
Q
s
2
) ( 4
2 1
3

= =
t
q
t
R
t
s
Fig. 6
4
Shear Force
5
Causes: atherosclerosis(), inflammatory processes leading to
stenosis(), an embolism(), or thrombus formation
Dieases:
1. Smoking - tobacco promote changes in endothelium which is a precursor to
atherosclerosis.
2. Diabetes mellitus - causing endothelial and smooth muscle cell dysfunction in
peripheral arteries.
3. Dyslipidemia (high [LDL], low [HDL]) - peripheral and/or coronary
atherosclerosis.
4. Hypertension - elevated blood pressure correlated with coronary and
cerebrovascular events (heart attack and stroke).
Physical exam:
1. Condition of skin and appendages
2. Pulses (absence tends to overestimate PAD)
3. Check for bruits
4. Pallor during leg elevation
5. Time for color return after leg restored to dependent position
6. ABI
Peripheral artery occlusion disease(PAOD)
Atherosclerosis
Fig. 7
6
ROS : reactive oxygen species
Pathways of Advanced Glycation End product
Fig. 8
7
Gene involvement in inflammation
Fig. 9
8
ABI(Ankle-Brachial Index)
Fig. 10
9
1.30>=Normal >=0.90
0.70 0.89 = mild disease
0.50 0.69 = moderate disease
<0.50 = severe disease (rest pain/tissue loss)
Fig. 11
However, ABPI has known
issues:
unreliable on patients with
arterial calcification
(hardening of the arteries)
which results in less or
incompressible arteries

Other Noninvasive Testing:
Segmental Pressure
Measurements
Pulse Volume Recordings
Duplex Scanning
MRA(Magnetic Resonance
Angiogram)
10
Windkessel, Elastic reservoir
Smoothing
the cardiac
pulsations
Intermittent
cardiac
ejection
Resistance
to blood
flow
Pressure
reservoir
Blood
reservoir
ABI(Ankle-Brachial Index)
Functionally Differentiated Segments of the Vascular Bed
Arterial stiffness
11
Oxygen supply
Oxygen demand
Fig. 12
Moens-Korteweg equation
ility Distensib
modulus Elastic
where
1

2
0
=
=
= =
D
E
D R
Eh
c
i

(Nitroglycerin)
b f m
P P P + =
Symptoms
12
About 20% of patients with mild PAD
may be asymptomatic; other symptoms
include:
1. Claudication - pain, weakness,
numbness, or cramping in muscles
due to decreased blood flow
2. Sores, wounds, or ulcers that heal
slowly or not at all
3. Noticeable change in color (blueness
or paleness) or temperature (coolness)
when compared to the other limb
(termed unilateral dependent rubor;
when both limbs are affected this is
termed bilateral dependent rubor)
4. Diminished hair and nail growth on
affected limb and digits.

Fig. 13
Symptoms
13
(
)()

1.
(Aspirin)(Clopidogrel
Plavix)
2.(Pentoxifylline
Trental)(Cilostazole
Pletal)
()

1.
2.

()

1.
2.
Fig. 14
14
Prognosis and Epidemiology
exceptionally elevated risk for cardiovascular events and the majority will
eventually die of a cardiac or cerebrovascular etiology
with claudication will develop coronary obstruction and ischemia
stroke and heart attack "5-year mortality rate is estimated to be 30% (versus 10%
in controls)
Prevalence
1. general population1214%
2. over 70 up to 20%
3. 70%80% of affected individuals are asymptomatic
4. incidence of symptomatic PVD increases with age
0.3% per year for men aged 4055 years
1% per year for men aged over 75 years


15
Summary
Fig. 15
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Summary
Fig. 16
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Fig. 17
Summary
Thanks for your attention
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