[show abstract][hide abstract] ABSTRACT: For the purposes of this chapter, peripheral arterial disease (PAD) refers to the development and progression of atherosclerotic
disease in the arteries of the lower extremities. A broader definition of peripheral arterial disease would encompass the
aorta and all its major visceral branches (carotid arteries, mesenteric arteries, renal arteries, and extremity arteries).
This chapter will not cover therapeutic considerations related to disease in each of these arterial beds.
Key WordsAmputation-Angioplasty-Atherosclerosis-Bypass surgery-Claudication-Gangrene
[show abstract][hide abstract] ABSTRACT: Peripheral arterial disease (PAD) is defined as an ankle-brachial index of less than 0.9. It is mostly prevalent in patients older than 50 years of age; its occurrence in younger patients is rare. Nevertheless, the diagnosis must be considered in any patient with exertional lower extremity symptoms. Patients with early-onset disease, also called premature PAD, have a particularly difficult course with early involvement of other major arterial beds such as the carotid and coronary arteries. Their diagnosis and treatment have to be comprehensive to prevent early morbidity and mortality. Reports of very early occurrence and management are rare, especially of onset before 25 years of age. Management of this early presentation of PAD is unclear because most of the available information concerns treatment of patients 40 years of age or older. The cases of two patients who developed symptomatic PAD before 25 years of age are described, and the various causes and management options available for the treatment of early onset PAD patients are discussed.
International Journal of Angiology 01/2009; 18(1):45-7.
[show abstract][hide abstract] ABSTRACT: Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis associated with a high risk of morbidity and mortality from cardiovascular events. Despite this, PAD is often undiagnosed and, therefore, undertreated.
The purpose of this review is to highlight and provide clinical insight into the similarities and differences between the available PAD treatment guidelines developed by the American College of Cardiology/American Heart Association (ACC/AHA) and the Trans-Atlantic Inter-Society Consensus II (TASC II) working group.
Recommendations from the ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) and TASC II Inter-Society Consensus for the Management of Peripheral Arterial users for personal Disease, initiated in 2004 and published in 2007, were compared. Supplemental information was obtained by searching the PubMed and MEDLINE databases using relevant terms. Unintentional bias may have been introduced into the manuscript by not performing a systematic review of the literature with pre-defined search terms.
While some variation exists in the content of the recommendations, both documents agree on the need for aggressive management of patients with PAD. In spite of these recommendations, there is a general lack of adherence to the current guidelines-a critical concern considering the high morbidity and mortality associated with the disease. However, the results of ongoing clinical trials may serve to increase awareness of the importance of aggressive management of PAD.
Current Medical Research and Opinion 08/2008; 24(9):2509-22. · 2.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: We determined whether statin use (vs. non-use) is associated with less annual decline in lower-extremity functioning in patients with and without lower-extremity peripheral arterial disease (PAD) over three-year follow-up.
It is unclear whether statin use is associated with less functional decline in patients with PAD.
Participants included 332 men and women with an ankle brachial index (ABI) <0.90 and 212 with ABI 0.90 to 1.50. Functional outcomes included 6-min walk distance and usual and rapid-pace 4-m walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for five repeated chair rises into an ordinal score ranging from 0 to 12 (12 = best).
Adjusting for age, race, gender, comorbidities, education, health insurance, total cholesterol/high-density lipoprotein level, body mass index, pack-years of smoking, leg symptoms, immediately previous year functioning, statin use/non-use, ABI, and change in ABI, the PAD participants using statins had less annual decline in usual-pace walking velocity (0.002 vs. -0.024 m/s/year, p = 0.013), rapid-pace walking velocity (-0.006 vs. -0.042 m/s/year, p = 0.006), 6-min walk performance (-34.5 vs. -57.9 feet/year, p = 0.088), and the summary performance score (-0.152 vs. -0.376, p = 0.067) compared with non-users. These associations were attenuated slightly by additional adjustment for high-sensitivity C-reactive protein levels. Among non-PAD participants, there were no significant associations between statin use and functional decline.
The PAD patients on statins have less annual decline in lower-extremity performance than PAD patients who are not taking statins.
Journal of the American College of Cardiology 03/2006; 47(5):998-1004. · 14.09 Impact Factor