PERIPHERAL ARTERIAL DISEASE

Peripheral Arterial Disease

Table of Contents

Introduction1

Epidemiology1

Classification2

Etiology2

Causes3

Symptoms4

Diagnosis of PAD5

Treatment8

Conclusion9

References11

Peripheral Arterial Disease

Introduction

The aging process is associated with the development of variable degrees of degenerative arterial disease. Longevity and quality of life may be improved by recognition, evaluation, and appropriate therapy of diseases that affect blood vessels. The purpose of this paper is to provide guidelines for recognition and management of the more commonly encountered problems of acute and chronic occlusive peripheral arterial disease (PAD) and of abdominal and peripheral arterial aneurysms.

Acute ischemia occurs when there is a sudden decrease in arterial perfusion of the lower extremities. It demands immediate recognition and management in an effort to minimize morbidity, including limb loss and death, because irreversible changes such as muscle necrosis, extensive arterial thrombosis, and neurological deficits may occur in the affected extremity as early as 4 to 6 hours after acute arterial occlusion.

Peripheral arterial disease (PAD) is an atherosclerosis which affects the lower extremities. PAD is a manifestation of systemic atherosclerosis and carries significant morbidity and mortality. Patients with PAD have the same relative risk of death as patients with known coronary artery disease (CAD) or cerebro-vascular disease. Thus, they need to be treated aggressively to reduce risk of cardiovascular events.

Epidemiology

Generally, PAD is under diagnosed and under treated due to disease unawareness and because symptoms may mimic other common conditions. In the UK over 100,000 people are newly diagnosed with PAD each year, and most practices will see six to eight patients with symptomatic, and more than ten asymptomatic, PAD patients a year. The prevalence of PAD increases markedly with age, affecting 3% of people under the age of 60 years of age, rising to over 20% in people over 75 years of age. Data from the Edinburgh Artery Study found a prevalence of intermittent claudication of 4.5% in the population aged 55 to 74 years.

Classification

Arterial vascular disease (AVD) refers to non-coronary atherosclerosis, which includes: cerebro-vascular disease, aortic disease, renal disease, and peripheral arterial disease.

Etiology

The risk factors for PAD are the same as for atherosclerosis.

Traditional risk factors: The presence of CAD or cerebro-vascular disease makes patients more prone to PAD. Cigarette smoking and diabetes carry the highest risk for PAD. Hypertension, dyslipidemia, particularly low high-density lipoprotein (HDL) and high triglycerides, and hyper-coagulability are important risk factors.

Novel risk factors for atherosclerosis. Lipoprotein (a), apolipoprotein (apo) A-1, apo B-100, high-sensitivity C-reactive protein (CRP), fibrinogen, and homocystine are new identifiable risks for atherosclerosis. Their roles in PAD are being investigated.

Genetic predisposition for collagen synthesis (Marfan syndrome, Ehler-Danlos IV syndrome) and inflammatory diseases (Takayasu artertitis) are rare, but carry significant risks for PAD.

Causes

The two major causes of acute arterial occlusion are cardio-arterial embolism and in situ thrombosis. Most large arterial emboli originate in the heart. Arrhythmias and mural thrombi are the major risk factors for embolisation. Rare sources of emboli include proximal arterial lesions such as aortic aneurysms or large ulcerative aortic plaques, which are commonly associated with arterial cholesterol microemboli. These microemboli may cause the “blue toe syndrome” (the acute ...