Overview of Peripheral Arterial Disease of the Lower Extremity

  • Ali F. AbuRahma


As the population continues to grow in average age, chronic lower extremity ischemia is becoming more prevalent. Recently, Dormandy et al. 1 reported the weighted mean incidence of intermittent claudication from five large population-based studies. The incidence ranged from two per 1000 men per year in the 30- to 54-year-old group to seven per 1000 in those over 65 years of age. In a recent summary of large population studies from Italy, Britain, Holland, and Finland, the prevalence of intermittent claudication increases gradually from <1% in 30-year-old men to 3% in 55- to 59-year-old men. The prevalence also increases starting at age 60, from 3% to over 7% in those 70 years old and older.2 It is believed that the overall incidence and prevalence of peripheral arterial disease are likely to increase significantly with the aging of the population, and it has been estimated that the number of individuals aged ≥65 will grow by 70% in the United States between 2010 and 2030.3


Peripheral Arterial Disease Popliteal Artery Common Iliac Artery Intermittent Claudication Posterior Tibial Artery 
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  1. 1.
    Dormandy J, Heeck L, Vig S. Intermittent claudication: Understated risks. Semin Vasc Surg 1999;12:96–108.PubMedGoogle Scholar
  2. 2.
    TransAtlantic Inter-Society Consensus (TASC) Working Group. Management of peripheral arterial disease (PAD). J Vasc Surg 2000;31:S5–S44, S54–S74.Google Scholar
  3. 3.
    Stanley JC, Barnes RW, Ernst CB, Hertzer NR, Mannick JA, Moore WS. Work Force Issues Report of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery, North American Chapter, Committee on Workforce Issues. J Vasc Surg 1996;23:172–181.Google Scholar
  4. 4.
    Crafts RC. Lower limb. In: Crafts RC (ed). A Textbook of Human Anatomy , pp. 397–517. New York: John Wiley, 1985.Google Scholar
  5. 5.
    Taylor LM, Porter JM, Winck T. Femoropopliteal occlusive disease. In: Greenfield LJ (ed). Surgery: Scientific Principles and Practice , 2nd ed., pp. 1810–1823. Philadelphia: JB Lippincott, 1997.Google Scholar
  6. 6.
    Zarins CK, Glagov S. Artery wall pathology in atherosclerosis. In: Rutherford RB (ed). Vascular Surgery , 4th ed., pp. 203–221. Philadelphia: WB Saunders, 1995.Google Scholar
  7. 7.
    Young DF, Cholvin NR, Kirkeeide RL, Roth AC. Hemodynamics of arterial stenosis at elevated flow rates. Circ Res 1977; 41:99–107.PubMedGoogle Scholar
  8. 8.
    Arfvidsson B, Wennmalm A, Gelin J, Dahllof AG, Hallgren B, Lundholm K. Covariation between walking ability and circulatory alterations in patients with intermittent claudication. Eur J Vasc Surg 1992; 6:642–646.CrossRefPubMedGoogle Scholar
  9. 9.
    Hiatt WR. Nonoperative, nonpharmacologic management of lower extremity occlusive disease. In: Ernst CB, Stanley JC (eds). Current Therapy in Vascular Surgery , pp. 530–533. Philadelphia: Mosby, 2000.Google Scholar
  10. 10.
    Hiatt WR, Wolfel EE, Regensteiner JG, Brass EP. Skeletal muscle carnitine metabolism in patients with unilateral peripheral arterial disease. J Appl Physiol 1992; 73:346–353.PubMedGoogle Scholar
  11. 11.
    Ross R, Glomset JA. The pathogenesis of atherosclerosis. N Engl J Med 1976; 295:369–377.PubMedGoogle Scholar
  12. 12.
    Taylor KE, Glagov S, Zarins CK. Preservation and structural adaptation of endothelium over experimental foam cell lesions. Arteriosclerosis 1989;9:881–894.PubMedGoogle Scholar
  13. 13.
    Faggiotto A, Ross R. Studies of hypercholesterolemia in the nonhuman primate. II. Fatty streak conversion to fibrous plaque. Arteriosclerosis 1984;4:341–356.PubMedGoogle Scholar
  14. 14.
    Glagov S, Zarins CK, Giddens DP, et al. Atherosclerosis: What is the nature of the plaque? In: Strandness DE Jr, Didishiem P, Clowes AW, et al. (eds). Vascular Diseases: Current Research and Clinical Application, pp. 15–33. Orlando, FL: Grune & Stratton, 1987.Google Scholar
  15. 15.
    Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and EKG abnormalities to incidence of major coronary events. J Chronic Dis 1978;31:201–306.CrossRefGoogle Scholar
  16. 16.
    Krupski WC, Rapp JH. Smoking and atherosclerosis. In: Goldstone J (ed). Perspectives of Vascular Surgery ,Vol. 1, pp. 103–134. St. Louis, MO: Quality Medical Publishing, 1988.Google Scholar
  17. 17.
    Powel JT. Vascular damage from smoking: Disease mechanisms at the arterial wall. Vasc Med 1998;3:21–28.Google Scholar
  18. 18.
    Murabito JM, D’Agostino RG, Silbershatz H, Wilson WF. Intermittent claudication: A risk profile from the Framingham heart study. Circulation 1997;96:44–49.PubMedGoogle Scholar
  19. 19.
    Celermajer DS, Sorensen KE, Georgakopoulos D, Bull C, Thomas O, Robinson J, Deanfield JE. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993;88:2149–2155.PubMedGoogle Scholar
  20. 20.
    Cheng SWK, Ting ACW, Wong J. Lipoprotein (a) and its relationship to risk factors and severity of atherosclerotic peripheral vascular disease. Eur J Vasc Endovasc Surg 1997;14:17–23.CrossRefPubMedGoogle Scholar
  21. 21.
    Blauw GJ, Lagaay AM, Smelt AH, Westendorp RG. Stroke, statins and cholesterol: A meta-analysis of randomized, placebo-controlled, double-blind trials with HMG-CoA reductase inhibitors. Stroke 1997;28:946–950.PubMedGoogle Scholar
  22. 22.
    Dormandy J, Heeck L, Vig S. Predictors of early disease in the lower limbs. Semin Vasc Surg 1999;12:109–117.PubMedGoogle Scholar
  23. 23.
    Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: Probable benefits of increasing folic acid intake. JAMA 1995;274:1049–1057.CrossRefPubMedGoogle Scholar
  24. 24.
    A Coordination Group in China. A pathological survey of atherosclerotic lesions of coronary artery and aorta in China. Pathol Res Pract 1985;180:457–462.Google Scholar
  25. 25.
    Stevens SL, Hilgarth K, Ryan VS, et al. The synergistic effect of hypercholesterolemia and mechanical injury on intimal hyperplasia. Ann Vasc Surg 1992;6:55.CrossRefPubMedGoogle Scholar
  26. 26.
    Steinberg D, Parthasarathy S, Carew T, et al. Modifications of low density lipoprotein that increase its atherogenicity. N Engl J Med 1989;320:915–924.PubMedCrossRefGoogle Scholar
  27. 27.
    Benditt EP. Implications of the monoclonal character of human atherosclerotic plaques. Am J Pathol 1977;86:693–702.PubMedGoogle Scholar
  28. 28.
    McCaffrey TA, Du B, Fu C, et al. The expressions of TGFbeta receptors in human atherosclerosis: Evidence of acquired resistance to apoptosis due to receptor imbalance. J Mol Cell Cardiol 1999;31:162T.CrossRefGoogle Scholar
  29. 29.
    Karayannacos PE, Talukder N, Nerem R, et al. The rule of multiple noncritical arterial stenoses in the pathogenesis of ischemia. J Thorac Cardiovasc Surg 1977;73:458–469.PubMedGoogle Scholar
  30. 30.
    Cronenwett JL. Arterial hemodynamics. In: Greenfield LJ (ed). Surgery—Scientific Principles and Practice, 2nd ed., pp. 1656–1667. Philadelphia: PA: JB Lippincott, 1997.Google Scholar
  31. 31.
    Imparato AM, Kim GE, Davidson T, et al. Intermittent claudication: Its natural course. Surgery 1975;78:795–799.PubMedGoogle Scholar
  32. 32.
    Boyd AM. The natural course of arteriosclerosis of lower extremities. Proc R Soc Med 1962;55:591–593.PubMedGoogle Scholar
  33. 33.
    Bloor K. Natural history of atherosclerosis of the lower extremities. Ann R Coll Surg Engl 1961;28:36–51.PubMedGoogle Scholar
  34. 34.
    Dormandy JA, Heeck L, Vig S. The natural history of claudication: Risk to life and limb. Semin Vasc Surg 1999;12:123–137.PubMedGoogle Scholar
  35. 35.
    Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL, Strandness DE Jr, Taylor LM. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: A critical review. Circulation 1996;94:3026–3049.PubMedGoogle Scholar
  36. 36.
    Dormandy JA, Murray GD. The fate of the claudicant: A prospective study of 1969 claudicants. Eur J Vasc Surg 1991;5:131–133.CrossRefPubMedGoogle Scholar
  37. 37.
    Criqui MH, Langer Rd, Fronek A, Feigelson HS, Klauber MR, McCann TJ, Browner D. Mortality over a period of ten years in patients with peripheral arterial disease. N Engl J Med 1992;326:381–386.PubMedCrossRefGoogle Scholar
  38. 38.
    McDermott MM, Feinglass J, Slavensky R, Pierce WH. The ankle-brachial index as predictor of survival in patients with peripheral vascular disease. J Gen Intern Med 1994;9:445–449.CrossRefPubMedGoogle Scholar
  39. 39.
    Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg 1997;26:517–538.CrossRefPubMedGoogle Scholar
  40. 40.
    Peabody CN, Kannel WB, McNamara PM. Intermittent claudication: Surgical significance. Arch Surg 1974;109:693–697.PubMedGoogle Scholar
  41. 41.
    Veith FJ, Gupta SK, Wengerter KR, et al. Changing arteriosclerotic disease patterns and management strategies in lower-limb-threatening ischemia. Ann Surg 1990;212:402–414.CrossRefPubMedGoogle Scholar
  42. 42.
    Yao JST. New techniques in objective arterial evaluation. Arch Surg 1973;106:600–604.PubMedGoogle Scholar
  43. 43.
    Masaryk TJ, Modic MT, Ruggieri PM, et al. Three dimensional (volume) gradient-echo imaging of the carotid bifurcation: Preliminary clinical experience. Radiology 1989;171:801–806.PubMedGoogle Scholar
  44. 44.
    Turnipseed WD. Diagnosis of carotid artery disease by digital subtraction angiography. In: AbuRahma AF, Dietrich EB (eds). Current Noninvasive Vascular Diagnosis , pp. 337–355. Littleton, MA: PSG Publishing, 1988.Google Scholar
  45. 45.
    Katayama H, Yamaguchi K, Kozuka T, et al. Adverse reactions to ionic and nanianic contrast media: a report from the Japanese Committee on the saftey of contrast media. Radiology 1990;175:621–628.Google Scholar
  46. 46.
    AbuRahma AF, Robinson PA, Boland JP, et al. Complications of arteriography in a recent series of 707 cases: Factors affecting outcome. Ann Vasc Surg 1993;7:122–129.CrossRefPubMedGoogle Scholar
  47. 47.
    Balduf LM, Langsfeld M, Marek JM, et al. Complication rates of diagnostic angiography performed by vascular surgeons. Vasc Endovasc Surg 2002;36:439–445.CrossRefGoogle Scholar
  48. 48.
    Pedersen TR, Kjekshus J, Pyorala K, Olsson AG, Cook TJ, Musliner TA, Robert JA, Haghfelt T. Effect of simvastatin on ischemic signs and symptoms in the Scandinavian Simvastatin Survival Study (4S). Am J Cardiol 1998;81:333–338.CrossRefPubMedGoogle Scholar
  49. 49.
    Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD. Cholesterol reduction yields clinical benefit: Impact of statin trials. Circulation 1998;97:946–952.PubMedGoogle Scholar
  50. 50.
    Bylund AC, Hammarsten J, Holm J, et al. Enzyme activities in skeletal muscles from patients with peripheral arterial insufficiency. Eur J Clin Invest 1976;6:425–429.CrossRefPubMedGoogle Scholar
  51. 51.
    Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain:A meta-analysis. JAMA 1995;274:975–980.CrossRefPubMedGoogle Scholar
  52. 52.
    Regensteiner JG, Steiner JF, Hiatt WR. Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 1996;23:104–115.CrossRefPubMedGoogle Scholar
  53. 53.
    Muller R. Hemorrheology and peripheral vascular disease. A new therapeutic approach. J Med 1981;12:209–235.PubMedGoogle Scholar
  54. 54.
    Porter JM, Cutler BS, Lee BY, et al. Pentoxifylline efficacy in the treatment of intermittent claudication. Am Heart J 1982;104:66–72.CrossRefPubMedGoogle Scholar
  55. 55.
    AbuRahma AF, Woodruff BA. Effects and limitations of pentoxifylline therapy in various stages of peripheral vascular disease of the lower extremity. Am J Surg 1990;160:266–270.CrossRefPubMedGoogle Scholar
  56. 56.
    Dawson DL. Comparative effects of cilostazol and other therapies for intermittent claudication. Am J Cardiol 2001;87:19D–27D.CrossRefPubMedGoogle Scholar
  57. 57.
    Comerota AJ. Endovascular and surgical revascularization for patients with intermittent claudication. Am J Cardiol 2001;87:34D–43D.CrossRefPubMedGoogle Scholar
  58. 58.
    Bates MC, AbuRahma AF. An update on endovascular therapy of the lower extremities. J Endovasc Therapy 2004; 11:II-107–II-127.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • Ali F. AbuRahma
    • 1
    • 2
  1. 1.Department of SurgeryRobert C. Byrd Health Sciences Center, West Virginia UniversityCharlestonUSA
  2. 2.Charleston Area Medical CenterCharlestonUSA

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