
		• The Atherosclerosis Risk in Communities Study: New Insights Regarding Peripheral Arterial Disease


		• AHA/ACC 2005 Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) • ACC/ACP/SCAI/SVMB/SVS Clinical competence statement on vascular medicine and catheter-based peripheral vascular interventions. • AHA Evidence-based guidelines for cardiovascular disease prevention in women. • AHA/ACC Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. • BETHESDA CONFERENCE REPORT Can atherosclerosis imaging techniques improve the detection of patients at risk for ischemic heart disease? • ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention. • WOCN Guideline for management of wounds in patients with lower-extremity arterial disease. • ACCP Consenus Panel Antithrombotic therapy in peripheral arterial occlusive disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. • ESC European guidelines on cardiovascular disease prevention in clinical practice. • SIR Guidelines for Percutaneous Transluminal Angioplasty. • SIR Quality Improvement Guidelines for Diagnostic Arteriography.


		• Angioplasty, Peripheral • Infrainguinal Occlusive Disease • Peripheral Vascular Disease • View All Peripheral Arterial Disease Articles


		• Infrainguinal occlusive disease - diabetic gangrene • Lower-extremity atherosclerotic arterial disease • Bilateral aortoiliac stenosis • Type I atherosclerosis with occlusive disease • View All Peripheral Arterial Disease Multimedia Files


		• Diabetes • High Blood Pressure • High Cholesterol • Peripheral Vascular Disease


		• Low Density Lipoprotein (LDL)

PERIPHERIAL ARTERIAL DISEASE RESOURCE CENTER

Obstructing plaques caused by atherosclerotic occlusive disease commonly occur in the infrarenal aorta and iliac arteries. Atherosclerotic plaques may induce symptoms by primarily obstructing blood flow through gradual progression to complete occlusion or by acutely fragmenting, which allows atherosclerotic and/or thrombotic debris to flow to more distal blood vessels. Emboli are usually of cardiac origin but can also come from proximal plaques, tumors, or foreign objects. Plaques large enough to obstruct the arterial lumen reduce blood flow to the extremities, with symptoms depending on the site and nature of occlusion and the presence of collateral circulation. Several risk factors (eg, sepsis, hypotension, low cardiac output, aortic dissection, intraluminal instrumentation) are associated with development of arterial lesions. Recognition of these factors and the clinical manifestations of the disease can enable physicians to use appropriate pharmacologic therapy to nonoperatively manage patients at risk for progression of the disease, thus alleviating symptoms, prolonging life, and effectively treating acute complications.

Angioplasty, Peripheral

Radiology

Atherosclerosis of peripheral vessels, or peripheral vascular disease (PVD) is the most common cause of symptomatic stenosis in human vascular tree. The pathogenetic mechanisms that lead to PVD are similar to those of coronary artery disease (CAD). The risk factors are also similar and include a positive family history, cigarette smoking, diabetes, hypertension, dyslipidemia, advanced age, and physical inactivity, among others.

Infrainguinal Occlusive Disease

Vascular Surgery

This article is a review of chronic infrainguinal atherosclerotic arterial occlusive disease caused by atherosclerosis involving the femoral, popliteal, and/or infrapopliteal arteries. Because chronic atherosclerotic disease may result in acute circulatory compromise, acute arterial occlusion is also covered. Less common etiologies of lower extremity arterial insufficiency, such as atheroembolism, Buerger disease, popliteal artery entrapment syndrome, and cystic adventitial disease, are briefly discussed.

Peripheral Vascular Disease

Emergency Medicine

Peripheral vascular disease (PVD) is a nearly pandemic condition that has the potential to cause loss of limb, or even loss of life. PVD manifests as insufficient tissue perfusion caused by existing atherosclerosis that may be acutely compounded by either emboli or thrombi. Many people live daily with PVD; however, in settings such as acute limb ischemia, this pandemic disease can be life threatening and can require emergency intervention to minimize morbidity and mortality.

Download a fully illustrated PAD presentation. The presentation encompasses PAD epidemiology, screening techniques, diagnostic criteria, risk factors, complications, differential diagnoses, and the role of the ankle-brachial index. Additionally, the pathophysiology of atherothrombosis, the medical therapy of claudication, and the management of cardiovascular risks are discussed, along with pharmacological, surgical, and endovascular options. Guidelines and future therapies are also presented.


Click icon for PAD Slide Library.	Click icon for PAD PDF file.

Quality of Life Instruments for Peripheral Arterial Disease: Room for Improvement

Recent developments in treatment options for peripheral arterial disease (PAD) have improved the prognosis; more patients survive longer. Newer treatment options for PAD, such as antiplatelet and claudication therapies, have aimed at preventing adverse cardiovascular events, limb loss, and the need for surgical interventions. In addition to these clinical benefits, the same treatment options enhance the quality of life (QOL) for with PAD by helping them live more productive and satisfying lives.

PAD News Archives
11/1/06 Peripheral Arterial Disease and Diabetes: Studies Reveal More Answers
10/1/06 Overcoming Aspirin Resistance in Patients With Peripheral Arterial Disease: Are We Getting Any Closer?
9/1/06 New Devices Offer Potential for Monitoring the Effects of Antiplatelet Therapy in Patients With Peripheral Arterial Disease
8/1/06 Functional Decline in Persons With Peripheral Arterial Disease: The Role of Exercise
7/1/06 Long-term Treatment of Percutaneous Coronary Intervention Patients With Extracardiac Vascular Disease
6/1/06 Ethnicity and Peripheral Artery Disease
The San Diego Population Study: Review and Clinical Commentary
5/1/06 Review of Findings and Clinical Implications of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) Trial
4/1/06 The Reduction of Atherothrombosis for Continued Health (REACH) Registry: An Update
3/1/06 Risk Factors for Peripheral Arterial Disease in the Community
2/1/06 Peripheral Arterial Disease and Adverse Cardiovascular Outcomes
1/9/06 Peripheral Arterial Disease Management Guidelines

A 56-Year-Old Smoker With Leg Pain

Earn free AMA PRA Category 1 Credit^TM by completing this case-based CME course about Julio S—, a 56-year-old Hispanic man who smokes, presents with leg pain upon walking. The pain has recently increased in intensity, reducing his quality of life. Julio first noticed “tightness” in his left leg approximately 6 months ago. He now has pain in his left calf, thigh, and buttock when walking the equivalent of 2 blocks. The pain disappears if he sits down to rest.

A 54-Year-Old Woman With Dyslipidemia and Fatigue

Earn free AMA PRA Category 1 Credit^TM by completing this case-based CME course about Deborah M—, a 54-year-old white woman with a history of dyslipidemia. During her annual physical, she notes that she has recently decreased her level of physical activity because of fatigue. Her lipid levels have been treated with diet, exercise, and atorvastatin. When questioned about her current level of exercise, she states that she and her husband have decreased their number of long hikes and bird-watching trips because she “gets tired easily.”

A 60-Year-Old Woman With Diabetes and Leg Pain

Earn free AMA PRA Category 1 Credit^TM by completing this case-based CME course about a 60-year-old white woman with diabetes who presents because of discomfort in her left calf while walking. The calf discomfort is fairly reproducible and comes on at even shorter distances when she walks uphill. When questioned about her level of physical activity, she notes that her family members avoid walking with her because she walks slowly, and she complains of needing to rest frequently.

A 63-Year-Old Man With Leg Pain

Earn free AMA PRA Category 1 Credit^TM by completing this case-based CME course about a 63-year-old man who reports having first noticed an aching pain, which he describes as a “charley horse,” localized to his left calf when walking about 8 months ago. Initially, the pain occurred after he had walked for about 12 minutes, but for the past 2 months, it appears after he walks for only 7-8 minutes. The pain is bad enough that the patient must stop to rest for a few minutes until it resolves. He denies having pain when standing, sitting, or lying down.

MRI-Guided Balloon Angioplasty to Treat Blood Flow Blockage in the Legs

This phase I clinical trial is evaluating clinical peripheral artery revascularization procedures guided wholly-or in part by real-time MRI. A state-of-the-art combined X-ray and MRI interventional suite has been constructed and equipped with real-time MRI image reconstruction for interventional experiments, patient monitoring and transport equipment for dual imaging modalities, and large-mammal preclinical simulation experiments.

Efficacy/Safety of Ecraprost in Lipid Emulsion for Treatment of Critical Leg Ischemia due to Peripheral Arterial Disease

This multicenter trial is evaluating the safety and efficacy of ecraprost in lipid emulsion, developed for the treatment of Critical leg ischemia (CLI), which is the most severe form of peripheral arterial disease (PAD). Primary outcomes include reduction in the proportion of subjects who experience a major amputation as well as reduction in proportion of subjects who die within 6 months from treatment initiation.

Effect of Niacin Extended Release and Lovastatin tablets on Walking in Patients with Intermittent Claudication (ICPOP)

This study is a randomized, double-blind, dose-comparison study designed to determine if Niacin ER/Lovastatin at two different doses compared to diet control (this group will receive a tablet containing 50 mg of immediate-release niacin) is a safe medicine that will reduce leg pain in subjects with intermittent claudication. Niacin ER/Lovastatin is a combination of two FDA (United States Food and Drug Administration) approved cholesterol modifying medications: Niaspan® (extended-release niacin) and lovastatin, a statin (the same medicine found in Mevacor®).

Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA. 2006 Feb 1;295(5):547-53.

Parekh RS, Zhang L, Fivush BA, Klag MJ. Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population. J Am Soc Nephrol. 2005 May;16(5):1420-6.

Wright JT Jr, Dunn JK, Cutler JA, Davis BR, Cushman WC, Ford CE, Haywood LJ, Leenen FH, Margolis KL, Papademetriou V, Probstfield JL, Whelton PK, Habib GB; ALLHAT Collaborative Research Group. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005 Apr 6;293(13):1595-608.

Logar CM, Pappas LM, Ramkumar N, Beddhu S. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study. BMC Nephrol. 2005 Mar 21;6(1):3.

Aronow WS. Management of peripheral arterial disease. Cardiol Rev. 2005 Mar-Apr;13(2):61-8.

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