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Overview of Peripheral Arterial Disease of the Lower Extremity

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Noninvasive Vascular Diagnosis

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Abstract

The overall prevalence of peripheral arterial disease (PAD) based on objective data has been evaluated in several epidemiological studies and is in the range of 3–10%, which increases to 10–20% in people over the age of 70 years. The prevalence of asymptomatic PAD of the lower extremity can only be estimated using noninvasive vascular testing in the general population with the ankle-brachial index (ABI) being the most widely used.

A number of risk factors for the development of atherosclerosis have been reasonably well established. These factors include hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes mellitus, stress, sedentary lifestyle, and family history.

Intermittent claudication as a symptom of peripheral arterial disease can be caused by flow-limiting stenosis, which is predominately secondary to atherosclerosis.

After the initial diagnosis of chronic lower extremity ischemia is made, it is important to stage the severity of the process accurately. This is crucial because the stage of the disease determines the natural history and outcome and which therapy is the most appropriate.

A variety of noninvasive tests are available for assessment of the lower extremity vascular system. Perhaps the most useful bedside noninvasive test available to the clinician is the ABI. The most commonly employed noninvasive testings used to confirm the disease, assess severity, and help its localization are segmental Doppler pressure, pulse volume recordings, and duplex ultrasound. Other important imaging modalities for determining the management strategies include magnetic resonance angiography (MRA), computed tomography angiography (CTA), and catheter-based angiography.

This chapter will review the basic anatomy, pathophysiology, clinical presentation, various noninvasive tests, and imaging for the diagnosis of peripheral arterial disease (PAD) of the lower extremities. It will also highlight the management outlines.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Ave., SE, Charleston, WV, 25304, USA

    Ali F. AbuRahma MD

  2. Department of Surgery,Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, Charleston, WV, USA

    John E. Campbell MD

Authors
  1. Ali F. AbuRahma MD
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  2. John E. Campbell MD
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Corresponding author

Correspondence to Ali F. AbuRahma MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    What resting ankle-brachial index (ABI) is most often used as a hemodynamic definition of peripheral arterial disease?

    1. a.

      ≤0.4

    2. b.

      ≤0.7

    3. c.

      ≤0.9

    4. d.

      ≤1.1

  2. 2.

    What is the clinical presentation of peripheral arterial disease?

    1. a.

      Critical limb ischemia with rest pain

    2. b.

      Critical limb ischemia with tissue loss

    3. c.

      Asymptomatic

    4. d.

      Intermittent claudication

    5. e.

      All of the above

  3. 3.

    Which risk factor does not increase an individual’s risk for the development of peripheral arterial disease?

    1. a.

      Smoking

    2. b.

      Diabetes mellitus

    3. c.

      Female gender

    4. d.

      Hyperlipidemia

    5. e.

      Chronic renal insufficiency

  4. 4.

    Development of nephrogenic systemic fibrosis is associated with the use of which contrast agent in patients with chronic renal failure?

    1. a.

      Iodinated contrast

    2. b.

      Gadolinium

    3. c.

      Neither

Answer Key

  1. 1.

    c. An ABI of ≤0.9 is most often used as the hemodynamic definition of peripheral arterial disease.

  2. 2.

    e. Patients with peripheral arterial disease can present with intermittent claudication, critical limb ischemia with rest pain or tissue loss, or be asymptomatic.

  3. 3.

    c. Female gender is not a risk factor for the development of peripheral arterial disease. The prevalence of peripheral arterial disease is slightly higher in men.

  4. 4.

    b. Gadolinium has been associated with the risk of developing nephrogenic systemic fibrosis when used in a patient with chronic renal failure.

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AbuRahma, A.F., Campbell, J.E. (2017). Overview of Peripheral Arterial Disease of the Lower Extremity. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_21

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_21

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  • Online ISBN: 978-3-319-54760-2

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