The term peripheral arterial disease (PAD) encompasses a number of disorders that affect the arterial beds of the body aside from the coronary arteries.1 The arteries of the lower extremities are one of the main areas affected by PAD. PAD is defined by an ankle-brachial index (ABI) of ≥ 0.90.2 PAD is a manifestation of atherosclerosis in the body and shares risk factors with coronary atherosclerosis. Data from the Framingham Heart Study determined the risk for developing PAD was increased when several common conditions were present including diabetes, hypercholesterolemia, cigarette smoking, and hypertension.3
PAD patients are often asymptomatic, but may present with symptoms of impaired lower extremity arterial circulation including aching, pain, discomfort, and fatigue in leg muscles upon exertion.2 Symptoms are relieved with rest. This type of leg ischemia is also referred to as intermittent claudication, or simply claudication.1 PAD is stratified in clinical practice guidelines based on presentation with the following classifications being used: asymptomatic, atypical leg pain, classic claudication, and critical limb ischemia.
The prevalence of PAD increases with age beginning after 40 years and affects 10% to 15% of the US population.2 Unfortunately, most patients with PAD do not know that they have the disease even though awareness is necessary for successful treatment. The presence of PAD is indicative of advanced atherosclerotic disease. Sixty percent of patients with PAD have polyvascular disease or manifestations of atherosclerosis in the cardiovascular or cerebrovascular systems as well.4 Therefore, PAD is considered a surrogate marker for coronary atherosclerosis.
Clinical history and physical examination findings are not reliable for detecting PAD; therefore diagnostic tests are critical.2 Diagnostic tests for PAD commonly are ABI and exercise treadmill testing. Segmental limb pressure and volume plethysmography can be used to verify and gauge the extent of disease. Duplex ultrasonography is used to evaluate anatomy and avoid unnecessary angiography. Computed tomographic angiography, magnetic resonance angiography, and contrast angiography may also play a role in the diagnosis and evaluation of PAD. Table 9-1 lists key factors associated with the clinical presentation of PAD.
TABLE 9-1 Clinical Presentation of Peripheral Arterial Disease |Favorite Table|Download (.pdf)
TABLE 9-1 Clinical Presentation of Peripheral Arterial Disease
|• Patients with PAD are likely to be 40 y of age and older with hypertension, hypercholesterolemia, diabetes, and/or a history of smoking.|
|Signs and Symptoms|
|• The clinical presentation of PAD is variable and includes symptoms ranging from no symptoms at all (typically early in the disease) to pain and discomfort.|
|• The two most common characteristics of PAD are intermittent claudication and pain at rest in the lower extremities.|
|• Intermittent claudication is regarded as the primary indicator of PAD. It is described as fatigue, discomfort, cramping, pain, or numbness in the affected extremities (typically the buttocks, thigh, or calf) during exercise and resolves within a few minutes at ...|