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Peripheral Arterial Disease

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Essential Cardiology

Abstract

Atherosclerotic peripheral arterial disease (PAD) refers to a range of non-coronary arterial vascular syndromes with progressive stenosis, occlusion, or aneurysmal dilation, most commonly affecting the lower extremity. Lower extremity PAD involves occlusive disease of the aorta, iliac, femoral, and more distal arteries. Patients with PAD typically carry a substantial burden of systemic atherosclerotic disease. Like other manifestations of atherosclerosis, the prevalence of PAD is related to hyperlipidemia, diabetes mellitus, hypertension, tobacco smoking, age, gender, and heredity. Clinical manifestations associated with lower extremity PAD include decrements in functional capacity and quality of life, intermittent claudication, and possibly limb loss. In addition, patients with PAD face an increased risk of vascular events including myocardial infarction (MI), stroke, and mortality.

The principles of management for patients with PAD involve measures directed at protecting affected tissues, preserving functional capacity, avoiding disease progression and arterial thrombosis, restoring blood flow, and preventing mortality. Treatment includes local measures, risk factor modification, drug therapy for claudication, and antithrombotic agents. If symptoms persist with conservative therapy, more invasive measures can be taken including atherectomy, balloon angioplasty, stenting, and surgery to overcome arterial obstruction and improve clinical outcomes.

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Recommended Reading

  • Abola MT, Bhatt DL, Duval S, Cacoub PP, Baumgartner I, Keo H, et al. Fate of individuals with ischemic amputations in the REACH registry: Three-year cardiovascular and limb-related outcomes. Atherosclerosis. 2012;221:527–35.

    Article  PubMed  CAS  Google Scholar 

  • Dieh C, Allenberg JR, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053–61.

    Article  Google Scholar 

  • Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300:197–208.

    Article  PubMed  CAS  Google Scholar 

  • Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr., White CJ, White J, White RA. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to develop guidelines for the management of patients with peripheral arterial disease [Lower extremity, renal, mesenteric, and abdominal aortic]). J Am Coll Cardiol. 2006;47:1239–312. Summary available at www.acc.org/clinical/guidelines/pad/summary.pdf

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    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, The Mount Sinai Hospital, 1 Gustave Levy Place, New York, NY, 10029, USA

    Giovina Lara Bomba MD

  2. Department of Medicine (Cardiology), Mount Sinai School of Medicine, New York, NY, USA

    Jonathan L. Halperin MD

  3. Clinical Cardiology Services, The Zena and Michael A. Weiner Cardiovascular Institute, The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA

    Jonathan L. Halperin MD

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  1. Giovina Lara Bomba MD
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Correspondence to Giovina Lara Bomba MD .

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Editors and Affiliations

  1. The Mount Sinai School of Medicine, The James J. Peters VA Medical Center, Department of Medicine, West Kingsbridge Rd 130, Bronx, 10468, New York, USA

    Clive Rosendorff

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Bomba, G.L., Halperin, J.L. (2013). Peripheral Arterial Disease. In: Rosendorff, C. (eds) Essential Cardiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6705-2_47

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