47. Peripheral Arterial Disease

Atherosclerotic peripheral arterial disease (PAD) refers to a range of non-coronary arterial vascular syndromes with progressive stenosis, occlusion, or aneurysmal dilation, most commonly affecting the lower extremity. Lower extremity PAD involves occlusive disease of the aorta, iliac, femoral, and more distal arteries. Patients with PAD typically carry a substantial burden of systemic atherosclerotic disease. Like other manifestations of atherosclerosis, the prevalence of PAD is related to hyperlipidemia, diabetes mellitus, hypertension, tobacco smoking, age, gender, and heredity. Clinical manifestations associated with lower extremity PAD include decrements in functional capacity and quality of life, intermittent claudication, and possibly limb loss. In addition, patients with PAD face an increased risk of vascular events including myocardial infarction (MI), stroke, and mortality.

The principles of management for patients with PAD involve measures directed at protecting affected tissues, preserving functional capacity, avoiding disease progression and arterial thrombosis, restoring blood flow, and preventing mortality. Treatment includes local measures, risk factor modification, drug therapy for claudication, and antithrombotic agents. If symptoms persist with conservative therapy, more invasive measures can be taken including atherectomy, balloon angioplasty, stenting, and surgery to overcome arterial obstruction and improve clinical outcomes.