280.2 🩺 國考版

280.2.1 高頻考點

280.2.1.1 Diagnosis Pearls

  • ABI ≀ 0.90 = PAD
  • TBI < 0.70 = abnormal (for non-compressible)
  • ABI > 1.40 = calcified (DM/CKD)
  • < 0.40 = CLTI
  • Exercise ABI for normal resting + symptoms

280.2.1.2 Treatment Algorithm

  1. Risk factor modification (smoking, DM, HTN, lipids)
  2. Antiplatelet (ASA or clopidogrel)
  3. Statin (atorvastatin 80)
  4. Supervised exercise (Class I)
  5. Cilostazol 100 BID for claudication (avoid in HFrEF)
  6. Rivaroxaban 2.5 BID + ASA if high MALE risk (COMPASS, VOYAGER)
  7. Revascularization for lifestyle-limiting claudication or CLTI

280.2.1.3 Key Trials

  • COMPASS 2017: low-dose rivaroxaban + ASA ↓ MACE + MALE
  • VOYAGER PAD 2020: same combo post-revasc
  • BEST-CLI 2022: GSV bypass > endo for CLTI if GSV available
  • CASPAR: ASA + clopidogrel after lower extremity bypass with prosthetic
  • CAPRIE: clopidogrel slightly better than ASA

280.2.1.4 High-Yield Drug Pearls

  • Cilostazol: PDE3i; AVOID in HFrEF (↑ mortality, similar to other PDE3i)
  • Rivaroxaban 2.5 BID: bleeding risk ↑ but acceptable for high-risk PAD/CAD
  • Statin: improves walking distance independent of LDL

280.2.2 易混淆比范

Type Onset Pulse Treatment
Acute limb ischemia Sudden (hours) Absent Heparin + revasc (CDT/surgery)
Chronic claudication Gradual (months) ↓ OMT + exercise; revasc if refractory
CLTI Subacute (weeks) Severely ↓ Urgent revasc
Buerger’s disease Subacute, young smoker ↓ distally Smoking cessation
Neurogenic claudication Insidious Normal Postural relief (sit/flex)

280.2.2.1 Foot Ulcer Patterns

Type Location Margin Pulse Pain
Arterial Toes, lateral malleolus “Punched out” Absent Severe
Venous Medial malleolus, gaiter area Irregular Present Mild
Neuropathic (DM) Plantar pressure points Hyperkeratotic Present Painless