Back مرض الشريان المحيطي Arabic Periferik arteriyaların daralması Azerbaijani Arteriopatia perifèrica Catalan Periferní cévní onemocnění Czech Periphere arterielle Verschlusskrankheit German Enfermedad vascular periférica Spanish بیماری سرخرگ محیطی Persian Artériopathie oblitérante des membres inférieurs French מחלת העורקים הפריפריאליים HE परिधीय संवहिनी रोग Hindi

Peripheral artery disease

Peripheral artery disease
Other namesPeripheral vascular disease (PVD), peripheral artery occlusive disease, peripheral obliterative arteriopathy
An arterial insufficiency ulcer in a person with severe peripheral artery disease[1]
SpecialtyInterventional radiology, vascular surgery
SymptomsLeg pain when walking that resolves with rest, skin ulcers, bluish skin, cold skin,[2][3] loss of hair, unusually smooth or shiny skin
ComplicationsInfection, amputation[4]
CausesAtherosclerosis, artery spasm[5][6]
Risk factorsCigarette smoking, diabetes, high blood pressure, high blood cholesterol.[4][7]
Diagnostic methodAnkle-brachial index < 0.90, duplex ultrasonography, angiography[8][9]
TreatmentStopping smoking, supervised exercise therapy, surgery[10][11][12]
MedicationStatins, ACE inhibitors, cilostazol[12]
Frequency155 million (2015)[13]
Deaths52,500 (2015)[14]

Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain.[5][15] PAD can happen in any blood vessel, but it is more common in the legs than the arms.[16]

When narrowing occurs in the heart, it is called coronary artery disease (CAD), and in the brain, it is called cerebrovascular disease.[4] Peripheral artery disease most commonly affects the legs, but other arteries may also be involved, such as those of the arms, neck, or kidneys.[4][17]

Peripheral artery disease (PAD) is a form of peripheral vascular disease. Vascular refers to both the arteries and veins within the body. PAD differs from peripheral veinous disease. PAD means the arteries are narrowed or blocked—the vessels that carry oxygen-rich blood as it moves away from the heart to other parts of the body. Peripheral veinous disease, on the other hand, refers to problems with veins—the vessels that bring the blood back to the heart.[18]

The classic symptom is leg pain when walking, which resolves with rest and is known as intermittent claudication.[2] Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg.[3] Complications may include an infection or tissue death, which may require amputation; coronary artery disease; or stroke.[4] Up to 50% of people with PAD do not have symptoms.[2]

The greatest risk factor for PAD is cigarette smoking.[4] Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol.[7][19] PAD is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis, especially in individuals over 40 years old.[6][20][16] Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis.[5][19] PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.[9] Duplex ultrasonography and angiography may also be used.[8] Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks.[9]

It is unclear if screening for peripheral artery disease in people without symptoms is useful, as it has not been properly studied.[21][22][20] For those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy may improve outcomes.[11][12] Medications, including statins, ACE inhibitors, and cilostazol, may also help.[12][23] Aspirin, which helps with thinning the blood and thus improving blood flow, does not appear to help those with mild disease but is usually recommended for those with more significant disease due to the increased risk of heart attacks.[20][24][25] Anticoagulants (blood thinners) such as warfarin show no definitive scientific evidence of benefit in PAD.[26] Surgical procedures used to treat PAD include bypass grafting, angioplasty, and atherectomy.[10]

In 2015, about 155 million people had PAD worldwide.[13] It becomes more common with age.[27] In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds.[7] In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90.[7] PAD in the developed world is equally common among men and women, though in the developing world, women are more commonly affected.[7] In 2015, PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990.[14][28]

  1. ^ Moore J (September 1, 2008). "Creating the Ideal Microcosm for Rapid Incorporation of Bioengineered Alternative Tissues Using An Advanced Hydrogel Impregnated Gauze Dressing: A Case Series". The Foot & Ankle Journal. doi:10.3827/faoj.2008.0109.0002.
  2. ^ a b c Violi F, Basili S, Berger JS, Hiatt WR (2012). "Antiplatelet Therapy in Peripheral Artery Disease". Antiplatelet Agents. Handbook of Experimental Pharmacology. Vol. 210. pp. 547–563. doi:10.1007/978-3-642-29423-5_22. ISBN 978-3-642-29422-8. PMID 22918746.
  3. ^ a b "What Are the Signs and Symptoms of Peripheral Arterial Disease?". nhlbi.nih.gov. August 2, 2011. Archived from the original on February 25, 2015. Retrieved February 26, 2015.
  4. ^ a b c d e f "What Is Peripheral Arterial Disease?". nhlbi.nih.gov. August 2, 2011. Archived from the original on February 25, 2015. Retrieved February 25, 2015.
  5. ^ a b c "What Is Peripheral Vascular Disease?" (PDF). American Heart Association (heart.org). 2012. Archived (PDF) from the original on April 12, 2015. Retrieved February 26, 2015. Peripheral artery disease (PAD) is the narrowing of the arteries to the legs, stomach, arms and head.
  6. ^ a b "What Causes Peripheral Arterial Disease?". nhlbi.nih.gov. August 2, 2011. Archived from the original on February 25, 2015. Retrieved February 26, 2015.
  7. ^ a b c d e Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. (October 2013). "Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis". Lancet. 382 (9901): 1329–1340. doi:10.1016/s0140-6736(13)61249-0. PMID 23915883. S2CID 38652734.
  8. ^ a b "How Is Peripheral Arterial Disease Diagnosed?". August 2, 2011. Archived from the original on April 7, 2015. Retrieved March 27, 2015.
  9. ^ a b c Ruiz-Canela M, Martínez-González MA (2014). "Lifestyle and dietary risk factors for peripheral artery disease". Circulation Journal. 78 (3): 553–559. doi:10.1253/circj.cj-14-0062. PMID 24492064.
  10. ^ a b "How Is Peripheral Arterial Disease Treated?". nhlbi.nih.gov. August 2, 2011. Archived from the original on February 25, 2015. Retrieved February 26, 2015.
  11. ^ a b Hageman D, Fokkenrood HJ, Gommans LN, van den Houten MM, Teijink JA (April 2018). "Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication". The Cochrane Database of Systematic Reviews. 2018 (4): CD005263. doi:10.1002/14651858.CD005263.pub4. PMC 6513337. PMID 29627967.
  12. ^ a b c d Hankey GJ, Norman PE, Eikelboom JW (February 2006). "Medical treatment of peripheral arterial disease". JAMA. 295 (5): 547–553. doi:10.1001/jama.295.5.547. PMID 16449620.
  13. ^ a b Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  14. ^ a b Wang H, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  15. ^ "Overview of Peripheral Arterial Disease – Heart and Blood Vessel Disorders". Merck Manuals Consumer Version. Retrieved April 30, 2019. Disorders of arteries that supply the brain with blood are considered separately as cerebrovascular disease.
  16. ^ a b Creager MA, Loscalzo J (2018). "Arterial Diseases of the Extremities Chapter 275". Harrison's Principles of Internal Medicine. 20. McGraw Hill. Retrieved April 10, 2023 – via Access Medicine.
  17. ^ Shantulli S (2018). "Update on peripheral arterial disease: Epidemiology and evidence-based facts". Atherosclerosis.
  18. ^ Gul F, Janzer SD (2023). "Peripheral Vascular Disease". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32491414. Retrieved April 10, 2023.
  19. ^ a b Harrison's principles of internal medicine (20 ed.). McGraw-Hill Education / Medical. 2018. ISBN 9781259644047.
  20. ^ a b c Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. (March 2017). "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Journal of the American College of Cardiology. 69 (11): 1465–1508. doi:10.1016/j.jacc.2016.11.008. PMID 27851991.
  21. ^ Andras A, Ferket B (April 2014). "Screening for peripheral arterial disease". The Cochrane Database of Systematic Reviews. 2014 (4): CD010835. doi:10.1002/14651858.CD010835.pub2. PMC 11103656. PMID 24711093.
  22. ^ U.S. Preventive Services Task Force (December 15, 2014). "Peripheral artery disease screening and cardiovascular disease risk assessment with the ankle-brachial index in adults: recommendation statement". Am Fam Physician. 90 (12): 858A – 858D. Archived from the original on March 31, 2017.
  23. ^ Brown T, Forster RB, Cleanthis M, Mikhailidis DP, Stansby G, Stewart M (June 2021). "Cilostazol for intermittent claudication". The Cochrane Database of Systematic Reviews. 2021 (6): CD003748. doi:10.1002/14651858.CD003748.pub5. PMC 8245159. PMID 34192807.
  24. ^ Lin JS, Olson CM, Johnson ES, Whitlock EP (September 2013). "The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 159 (5): 333–341. doi:10.7326/0003-4819-159-5-201309030-00007. PMID 24026319. S2CID 9350462.
  25. ^ Poredos P, Jezovnik MK (March 2013). "Is aspirin still the drug of choice for management of patients with peripheral arterial disease?". VASA. Zeitschrift für Gefässkrankheiten. 42 (2): 88–95. doi:10.1024/0301-1526/a000251. PMID 23485835.
  26. ^ Hauk L (May 2012). "ACCF/AHA update peripheral artery disease management guideline". American Family Physician. 85 (10): 1000–1001. PMID 22612053.
  27. ^ Creager MA, Beckman JA, Loscalzo J (2013). Vascular medicine : a companion to Braunwald's heart disease (2nd ed.). Philadelphia, PA: Elsevier/Saunders. ISBN 9781455737369. OCLC 810335904.
  28. ^ GBD 2013 Mortality and Causes of Death Collaborators (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. {{cite journal}}: |author1= has generic name (help)CS1 maint: numeric names: authors list (link)
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