Peripheral artery disease (PAD) also known as Peripheral vascular disease (PVD) as well as several others is a very prevalent form of atherosclerotic cardiovascular disease. PAD effects 4% of patients over age 40 and 15-20% of patients over 65 years of age. Approximately 8-10% of Americans have PAD, however, only 10-30% have the classic symptom of leg claudication: a feeling of tightness, burning, or fatigue in the calves or hips/buttocks.
There are a number of well-known risk factors for the development of PAD. These include (in order of highest to lowest risk): cigarette smoking, Diabetes, Hypertension and
hypercholesterolemia. It is important to note that each 10% rise in total cholesterol translates into a 10% increased risk of developing PAD. PAD is an age-related condition which is rarely seen before the age of 40 and is extremely prevalent in individuals over 65. Male smokers between 55 and 64 who smoke more than 2 packs per day have a 5X higher incidence of PAD than nonsmokers.
PAD can manifest in a number of differing way depending on the vascular territory involved and the severity of the circulatory impairment. Symptoms are highly variable and range from transient neurologic symptoms to problems involving the GI tract to non-healing ulcers of the legs and feet. The treatment of these differing forms of PAD varies and includes exercise, medical therapy, endovascular interventions (angioplasty and stenting) and surgery. The remainder of this article will focus on classic atherosclerotic PAD of the lower extremities.
Once a clinician considers PAD as a cause of their patients’ symptoms typically an arterial ultrasound of the lower extremities is obtained to assess the status of a patients’ circulation. Depending on the results further work up including angiography may be indicated. Angiography is typically an invasive dye test to outline the arteries of the lower extremities in order to plan the appropriate therapy.
The most feared complication of PAD is the need for amputation. Patients with chronic limb ischemia (CLI) are predisposed to ulceration and possible amputation. The need for amputation also significantly increases the risk of cardiovascular and overall mortality. The far-reaching effects of PAD include a significant increase in cardiovascular risk as well as mortality. As the blood pressure in the lower extremities falls to less than to less than 60% of the arm BP overall cardiovascular risk increases (heart attack and stroke) by approximately 8-fold. By 10 years of severe large vessel PAD survival decreases by 75% due mostly to major adverse cardiovascular events. The five-year mortality of PAD is greater than Hodgkin’s and breast cancer topped only by colorectal and lung cancer.
Peripheral artery disease is quite prevalent in our population especially as the baby boomers continue to age. There are a number of risk factors associated with the development of PAD. PAD incidence increases with age and is rare before 40 and common after age 70. Men are affected more than women. Therapies vary and should include a walking program (where appropriate), attention to BP, cholesterol, diabetes and smoking. Persons who are increased risk or have symptoms should seek medical attention as therapies for PAD continue to evolve and improve.