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Comprehensive Cardiovascular Medicine in the Primary Care Setting pp 311–323Cite as

Peripheral Arterial Disease

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Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

For the purposes of this chapter, peripheral arterial disease (PAD) refers to the development and progression of atherosclerotic disease in the arteries of the lower extremities. A broader definition of peripheral arterial disease would encompass the aorta and all its major visceral branches (carotid arteries, mesenteric arteries, renal arteries, and extremity arteries). This chapter will not cover therapeutic considerations related to disease in each of these arterial beds.

Key Points

• Peripheral arterial disease (PAD) is common and highly underdiagnosed.

• Patients with PAD have a higher rate of cardiovascular events than the highest risk groups predicted by the Framingham risk score, up to 20% over 5 years.

• Over half of PAD patients have concomitant coronary artery disease.

• The National Cholesterol Education Program recognizes PAD as a coronary heart disease (CHD) risk equivalent, which defines these patients as being at high risk for CHD-related events, such as myocardial infarction and death.

• Only one-third of patients with PAD have typical calf symptoms of claudication.

• All patients at risk of PAD should be screened with the simple, non-invasive, inexpensive ankle–brachial index (ABI). The ABI is 95% sensitive and 99% specific for the diagnosis of PAD.

• Management of PAD involves two paths: aggressive treatment of cardiovascular risk factors to decrease cardiovascular events and mortality as well as treatment of lower extremity symptoms.

• Lower extremity revascularization is never indicated in the asymptomatic patient. However, aggressive risk factor modification should be undertaken in all PAD patients.

• Consensus guidelines for PAD are produced by two major societies, the American College of Cardiology/American Heart Association (ACC/AHA) and the Trans-Atlantic Intersociety Consensus Working Group (TASC-II). Recommendations from the two societies are largely concordant.

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Author information

Authors and Affiliations

  1. Cardiovascular Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Jay Giri MD

  2. Department of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Emile R. Mohler III MD

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  1. Jay Giri MD
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  2. Emile R. Mohler III MD
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Editors and Affiliations

  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Giri, J., Mohler, E.R. (2011). Peripheral Arterial Disease. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_16

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  • DOI: https://doi.org/10.1007/978-1-60327-963-5_16

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