Peripheral Arterial Disease (PAD)

PAD started as a new subtopic June 5, 2006.

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PAD

NIH - Arteriosclerosis of the extremities

"Arteriosclerosis of the extremities is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. This causes a decrease in blood flow that can injure nerves and other tissues. Arteriosclerosis, or "hardening of the arteries," commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on ordinary X-rays. This is a common disorder, usually affecting men over 50 years old. People are at higher risk if they have a personal or family history of coronary artery disease (heart disease) or cerebrovascular disease (stroke), diabetes, smoking, hypertension (high blood pressure), or kidney disease involving hemodialysis."

Highlighted Article

Medical treatment of peripheral arterial disease.

"CONTEXT: Peripheral arterial disease (PAD) affects approximately 20% of adults older than 55 years and is a powerful predictor of myocardial infarction, stroke, and death due to vascular causes. The goals of treatment are to prevent future major coronary and cerebrovascular events and improve leg symptoms. … CONCLUSION: The substantial and increasing burden of PAD, and its local and systemic complications, can be reduced by lifestyle modification (smoking cessation, exercise) and medical therapies (nicotine replacement therapy, bupropion, antihypertensive drugs, statins, and antiplatelet drugs)."

PAD

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Peripheral Arterial Disease

Peripheral artery disease

JOURNAL ARTICLES:

Blood Pressure in Patients with Intermittent Claudication Increases Continuously During Walking. (Eur J Vasc Endovasc Surg. 2006) "CONCLUSIONS: In patients with PAD, blood pressure increased continuously and significantly when walking to MCD (dynamic exercise). The level of increase in blood pressure was similar to that caused in response to isometric exercise."

Does the Clinical Examination Predict Lower Extremity Peripheral Arterial Disease? (JAMA. 2006) "The PAD screening score using the hand-held Doppler has the greatest diagnostic accuracy."

Epidemiology and pathophysiology of lower extremity peripheral arterial disease. (J Endovasc Ther. 2006) "PAD is mostly silent in its early stages, but when lesion obstruction exceeds 50%, it may cause intermittent claudication with ambulation. Further disease progression typically leads to rest pain or frank tissue loss. However, some patients may remain asymptomatic with severe disease because of extensive collateralization in the lower extremity. Estimates of the prevalence of intermittent claudication vary by population, from 0.6% to nearly 10%; the rate increases dramatically with age. Approximately 20% to 25% of patients will require revascularization, while fewer than 5% will progress to critical limb ischemia. . Typical risk factors include age, gender, diabetes, tobacco abuse, hypertension, and hyperlipidemia."

[Epidemiology of peripheral arterial disease in Germany. What is evident, what remains unclear?] (Hamostaseologie. 2006)

Functional decline in patients with and without peripheral arterial disease: predictive value of annual changes in levels of C-reactive protein and D-dimer. (J Gerontol A Biol Sci Med Sci. 2006) "BACKGROUND: Inflammation may be a potential mechanism of aging-related functional decline. We determined whether greater annual increases in levels of high sensitivity C-reactive protein (hsCRP) and D-dimer predicted greater decline in functioning among persons with and without lower extremity peripheral arterial disease (PAD). . CONCLUSION: These findings suggest that inflammation may play a role in functional decline in persons with and without PAD."

Incidental Renal Artery Stenosis Is an Independent Predictor of Mortality in Patients with Peripheral Vascular Disease. (J Am Soc Nephrol. 2006) "In patients with peripheral vascular disease (PVD), mortality is high and renal artery stenosis (RAS) is a frequent incidental finding. RAS carries a high risk for mortality, but whether incidentally discovered RAS is a risk factor for mortality is unknown. . Incidental RAS was a frequent finding and an independent predictor for mortality. Whether RAS is a marker for or, alternatively, a mediator of the poor prognosis and whether prognosis can be improved by specific intervention should be the subject of future prospective studies."

Increased prevalence of peripheral arterial disease in osteoporotic postmenopausal women. (J Bone Miner Metab. 2006) "This study shows for the first time an increased prevalence of PAD among osteoporotic postmenopausal women, with a lower femoral neck BMD T score being a significant independent predictor."

Inflammation and Chlamydia pneumoniae infection correlate with the severity of peripheral arterial disease. (Eur J Vasc Endovasc Surg. 2006) "CONCLUSION: This study supports the hypothesis that inflammation (CRP) and chronic C. pneumoniae infection (IgA seropositivity), have an important role in lower limb atherosclerosis and correlate with the severity of the disease."

Intermittent claudication: An overview. (Atherosclerosis. 2005) "Intermittent claudication (IC) is defined by leg muscle pain, cramping and fatigue brought on by ambulation/exercise; relieved on rest; and caused by inadequate blood supply and is the primary symptom of peripheral arterial disease (PAD). PAD has a detrimental effect on the quality of life. PAD is a debilitating atherosclerotic disease of the lower limbs and is associated with an increased risk of cardiovascular morbidity and mortality. IC is an extremely important marker of atheroma. Up to 60% patients with IC have significant underlying coronary and/or carotid disease and 40% of all patients suffering from IC die or suffer a stroke within 5 years of presentation. . Although exercise therapy is one of the most efficacious conservative treatments for claudication, the pharmacotherapeutic goals can be best achieved through an increase in the walking capacity to improve quality of life and a decrease in rates of amputation. In the development of treatment for IC, an aggressive non-pharmacological intervention and pharmacological treatment of the risk factors associated with IC are considered."

JAMA patient page. Peripheral arterial disease. (JAMA. 2006)

Markers of vascular inflammation are associated with the extent of atherosclerosis assessed as angiographic score and treadmill walking distances in patients with peripheral arterial occlusive disease. (Vasc Med. 2006) "The importance of inflammation in atherosclerosis is well established in cardiovascular disease. However, limited data exist on the relationship between vascular inflammation and the severity of peripheral arterial occlusive disease (PAD). . The importance of inflammation in atherosclerosis is well established in cardiovascular disease. However, limited data exist on the relationship between vascular inflammation and the severity of peripheral arterial occlusive disease (PAD)."

Mitochondrial defects and oxidative damage in patients with peripheral arterial disease. (Free Radic Biol Med. 2006) "Peripheral arterial disease is associated with abnormal mitochondrial function and evidence of significant oxidative stress."

Peripheral arterial disease and ankle-brachial pressure index as predictors of mortality in residents of Metlika County, Slovenia. (Croat Med J. 2006) "CONCLUSION: Peripheral arterial disease, even asymptomatic, is an important predictor of adverse cardiovascular prognosis in relatively young patients. Reduced ABPI is a strong, independent predictor of cardiovascular mortality in all patients with peripheral arterial disease."

Peripheral arterial disease and cardiovascular risk in Italy. Results of the Peripheral Arteriopathy and Cardiovascular Events (PACE) study. (J Cardiovasc Med (Hagerstown). 2006) "CONCLUSIONS: This Italian study shows that, in general practice, symptomatic PAD is associated with a four-fold increased risk of mortality and a nearly eight-fold increased risk of cardiovascular mortality. These figures are quite similar to those reported in northern European and northern American populations. General practitioners, who are the clinicians primarily and largely responsible for the care of these patients, should be alerted to the consequences of PAD."

Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. (Diabetes Care. 2006) "CONCLUSIONS: Measurement of the ABI is a simple means of identifying PAD in diabetic patients. PAD is common in diabetic patients and predicts cardiac death. These data further support the role of regular screening for PAD in diabetes so that intensive management of vascular risk factors can be pursued."

Peripheral arterial disease in patients with stages IV and V chronic renal failure. (Nephrol Dial Transplant. 2006) "CONCLUSIONS: The present study, conducted on CRF patients in stages IV and V not undergoing dialysis, showed; (a) that a high percentage of these patients developed PAD (19%) or other vascular pathologies; (b) that there was an associated high mortality rate (29%) after 5 years; (c) that the 5-year mortality rate was significantly higher (P = 0.004) in PAD patients (64 vs 20%)."

[Peripheral artery disease of the lower limbs and morbidity/mortality in type 2 diabetics.] (Aten Primaria. 2006) "CONCLUSIONS. The type 2 diabetics with PAD present with a higher morbidity and mortality. The ABI is a good predictor of cardiovascular disease and heart failure morbidity and mortality."

Peripheral arterial disease versus other localizations of vascular disease: the ATTEST study. (J Vasc Surg. 2006)

Prevalence of peripheral arterial disease - results of the heinz nixdorf recall study. (Eur J Epidemiol. 2006) "The overall prevalence of PAD according to the ABI criteria was 6.4% among men and 5.1% among women. After accounting for history of PAD, the prevalence increased to 8.2% among men and 5.5% among women. Taking the ABI criteria and medical history into account, males had a higher prevalence of PAD, with large increases in males aged 65-69 and 70-75 years."

Sensory neuropathy and signs of central sensitization in patients with peripheral arterial disease. (Pain. 2006) "Patients with peripheral arterial disease (PAD) may develop a broad range of peripheral nerve dysfunctions including pain and sensory deficiencies due to chronic ischemia mostly involving the lower limbs. . In patients with severe PAD, sensory deficits were more pronounced than in patients with moderate PAD and were detected even in the face."

The relationship of periodontal disease to cardiovascular diseases--review of literature. (J Pak Med Assoc. 2006) "A chronic oral infection such as periodontitis is a constant potential source of infection and has now been considered as a separate risk factor for cardiovascular diseases, cerebrovascular diseases, peripheral arterial disease and respiratory diseases as well as delivery of low-birth-weight infants. The possible pathways linking oral infections to systemic diseases are metastatic infections, bacterial endotoxins, and systemic vascular injury. People with a history of periodontal disease and/or tooth loss were found at higher risk for Peripheral arterial disease (PAD) as compared to those without periodontal disease and/or tooth loss."

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