Highlights & Basics
- Peripheral arterial disease (PAD) is most commonly caused by atherosclerosis.
- Most patients are asymptomatic.
- Patients require aggressive risk factor control.
- Long-term patency of lower-extremity revascularization should be monitored with a surveillance program.
- First line of therapy for patients with lifestyle-limiting claudication is a supervised 12-week exercise program and medication. Revascularization should be considered if these therapies fail.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Wound
Ischemia (ABI: ankle-brachial index; TP: toe pressure; TcPO2: transcutaneous oximetry)
Foot infection (PACO2: partial pressure of arterial carbon dioxide; SIRS: systemic inflammatory response syndrome)
Clinical stages (major limb amputation risk) based on Wound, Ischemia, and foot Infection (WIfI) classification
Citations
Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J. 2018 Mar 1;39(9):763-816.[Abstract][Full Text]
Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Circulation. 2017 Mar 21;135(12):e686-725.[Abstract][Full Text]
Norgren L, Hiatt WR, Dormandy JA, et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5-67.[Abstract][Full Text]
Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34;e1-2. [Abstract][Full Text]
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2. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Circulation. 2017 Mar 21;135(12):e686-725.[Abstract][Full Text]
3. Norgren L, Hiatt WR, Dormandy JA, et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5-67.[Abstract][Full Text]
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45. Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34;e1-2. [Abstract][Full Text]
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47. TASC Steering Committee; Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vasc Med. 2015 Oct;20(5):465-78. [Abstract]
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58. Iida O, Yokoi H, Soga Y, et al; STOP-IC investigators. Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the Sufficient Treatment of Peripheral Intervention by Cilostazol study. Circulation. 2013 Jun 11;127(23):2307-15.[Abstract][Full Text]
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62. Ubbink DT, Vermeulen H. Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia. Cochrane Database Syst Rev. 2013;(2):CD004001.[Abstract][Full Text]
63. Liu Y, Xu Y, Fang F, et al. Therapeutic efficacy of stem cell-based therapy in peripheral arterial disease: a meta-analysis. PLoS One. 2015 Apr 29;10(4):e0125032. [Abstract]
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99. Medicines and Healthcare products Regulatory Agency. Recommendations for ongoing use of paclitaxel drug coated balloons (DCBs) and implantable drug eluting stents (DESs) in the treatment of patients with peripheral artery disease (PAD) (MDA/2019/023R). June 2019 [internet publication].[Full Text]
100. Gryka RJ, Buckley LF, Anderson SM. Vorapaxar: the current role and future directions of a novel protease-activated receptor antagonist for risk reduction in atherosclerotic disease. Drugs R D. 2017 Mar;17(1):65-72. [Abstract]
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