Peripheral Arterial Disease

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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)."

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Peripheral Arterial Disease

Diagnosis, Imaging, and Screening

NEWS:

Time for PAD to Come Out of the Shadows, Say GetABI Researchers "Screening for peripheral arterial disease (PAD) should be performed routinely in all elderly patients and younger ones with cardiovascular risk factors, says Dr Curt Diehm (Affiliated Teaching Hospital, Karlsbad-Langensteinbach, Germany), who reported the results of the German epidemiological study on ankle brachial index (getABI) during the hotline session at the European Society of Cardiology congress today. And those found to have PAD should be treated in the same way as patients with coronary artery disease (CAD), he said, stressing that PAD patients are currently undertreated."

ARTICLES:

JOURNAL ARTICLES:

Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects. (J Vasc Surg. 2007)

[Importance of the Ankle-Brachial Index (ABI) in the Prevention of Cardiovascular Diseases. Ten Questions and Answers.] (Herz. 2007)

Peripheral Artery Disease (images)

The ankle-brachial pressure index and a standardized questionnaire are easy and useful tools to detect peripheral arterial disease in non-claudicating patients at high risk. (Int Angiol. 2007)

The Association between Ankle-Brachial Index and Cardiovascular or All-Cause Mortality in Metabolic Syndrome of Elderly Chinese. (Hypertens Res. 2007) "Our results suggest the urgent need for repeated ABI measurement in clinical practice, both during individual visits and also over time, before diagnosing peripheral artery disease and making a therapeutic decision, especially in certain high-risk populations such as patients with MetS."

The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001 (BMC Cardiovascular Disorders 2007) "African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors."

Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. (Nutr Metab Cardiovasc Dis. 2007) "CONCLUSIONS: We conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment."

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