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. 2010 Jul;85(7):678-92.
doi: 10.4065/mcp.2010.0133.

Peripheral artery disease: current insight into the disease and its diagnosis and management

Jeffrey W Olin  1 , Brett A Sealove
Affiliations

Peripheral artery disease: current insight into the disease and its diagnosis and management

Jeffrey W Olin et al. Mayo Clin Proc. 2010 Jul.

Abstract

Peripheral artery disease (PAD), which comprises atherosclerosis of the abdominal aorta, iliac, and lower-extremity arteries, is underdiagnosed, undertreated, and poorly understood by the medical community. Patients with PAD may experience a multitude of problems, such as claudication, ischemic rest pain, ischemic ulcerations, repeated hospitalizations, revascularizations, and limb loss. This may lead to a poor quality of life and a high rate of depression. From the standpoint of the limb, the prognosis of patients with PAD is favorable in that the claudication remains stable in 70% to 80% of patients over a 10-year period. However, the rate of myocardial infarction, stroke, and cardiovascular death in patients with both symptomatic and asymptomatic PAD is markedly increased. The ankle brachial index is an excellent screening test for the presence of PAD. Imaging studies (duplex ultrasonography, computed tomographic angiography, magnetic resonance angiography, catheter-based angiography) may provide additional anatomic information if revascularization is planned. The goals of therapy are to improve symptoms and thus quality of life and to decrease the cardiovascular event rate (myocardial infarction, stroke, cardiovascular death). The former is accomplished by establishing a supervised exercise program and administering cilostazol or performing a revascularization procedure if medical therapy is ineffective. A comprehensive program of cardiovascular risk modification (discontinuation of tobacco use and control of lipids, blood pressure, and diabetes) will help to prevent the latter.

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Figures

FIGURE 1.
FIGURE 1.
Natural history of peripheral artery disease (PAD). CLI = critical limb ischemia; CV = cardiovascular; MI = myocardial infarction. From Circulation, with permission of the American Heart Association.
FIGURE 2.
FIGURE 2.
Calculation of the ankle brachial index (ABI). DP = dorsalis pedis; PT = posterior tibial artery. Adapted from N Engl J Med, with permission. ©2001 Massachusetts Medical Society. All rights reserved.
See this image and copyright information in PMC

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