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Peripheral artery disease and intermittent claudication - Highlights

Description

An in-depth report on the causes, diagnosis, and treatment of peripheral artery disease (PAD).

Alternative Names

Peripheral arterial disease; PAD; Peripheral vascular disease;

Highlights:

Peripheral Artery Disease

Peripheral artery disease (PAD) is a type of atherosclerosis. It occurs when arteries in the limbs (most often the legs) become narrowed by cholesterol-rich material called plaque. Because PAD interferes with circulation, advanced cases increase the risk for gangrene and amputation. Patients with PAD are also at increased risk for heart attacks and strokes.

Risk Factors of PAD

The main risk factors of PAD include:

Smoking
Diabetes
Unhealthy cholesterol and lipid levels
High blood pressure
Advancing age

Symptoms

Many people with PAD do not have symptoms. When symptoms do occur, crampy leg pain (intermittent claudication) is the main symptom. This symptom occurs off and on, usually with exercise, and disappears when at rest. When PAD becomes more severe, symptoms can include:

Pain or tingling in the feet or toes
Weakened calf muscles
Painful non-bleeding ulcers on the feet or toes that do not heal

Treatment

Treatment for PAD includes both lifestyle measures and medications that help reduce symptoms and prevent disease progression. These include:

Regular exercise, which is essential for patients with PAD
Heart-healthy diet, low in saturated fat, to reduce unhealthy cholesterol levels
Smoking cessation
Medications to help control high blood pressure and cholesterol. Other drugs include antiplatelet medications to prevent blood clots and phosphodiesterase inhibitors to help improve walking distance.
In severe cases, surgery may be needed to open blocked blood vessels.

Resources

www.padcoalition.org -- Peripheral Arterial Disease Coalition
www.nhlbi.nih.gov -- National Heart, Lung, and Blood Institute
www.americanheart.org -- American Heart Association
www.acc.org -- American College of Cardiology
www.diabetes.org -- American Diabetes Association
www.vdf.org -- Vascular Disease Foundation
www.sirweb.org -- Society of Interventional Radiology

References

Aboyans V, Criqui MH, Denenberg JO, Knoke JD, Ridker PM, Fronek A. Risk factors for progression of peripheral arterial disease in large and small vessels. Circulation. 2006 Jun 6;113(22):2623-9.

Arain FA, Cooper LT Jr. Peripheral arterial disease: diagnosis and management. Mayo Clin Proc. 2008 Aug;83(8):944-49; quiz 949-50.

Aung PP, Maxwell HG, Jepson RG, Price JF, Leng GC. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000123.

Collins R, Burch J, Cranny G, Aguiar-Ibáñez R, Craig D, Wright K, et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ. 2007 Jun 16;334(7606):1257. Epub 2007 Jun 4

Creager MA and Libby P. Peripheral arterial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 57.

Garg PK, Tian L, Criqui MH, Liu K, Ferrucci L, Guralnik JM, et al. Physical activity during daily life and mortality in patients with peripheral arterial disease. Circulation. 2006 Jul 18;114(3):242-8.

Kikano GE, Brown MT. Antiplatelet therapy for atherothrombotic disease: an update for the primary care physician. Mayo Clin Proc. 2007 May;82(5):583-93.

McDermott MM, Ades P, Guralnik JM, Dyer A, Ferrucci L, Liu K, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. 2009 Jan 14;301(2):165-74.

Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA. 2009 Jan 28;301(4):415-24.

Saw J, Bhatt DL, Moliterno DJ, Brener SJ, Steinhubl SR, Lincoff AM, et al. The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials. J Am Coll Cardiol. 2006 Oct 17;48(8):1567-72.

Sobel M, Verhaeghe R; American College of Chest Physicians; American College ofChest Physicians. Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):815S-843S.

Steg PG, Bhatt DL, Wilson PWF, D’Agostino R, Ohman EM, Rother, J. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. Mar 21 2007;29(11)7:1197-1206.

Warfarin Antiplatelet Vascular Evaluation Trial Investigators, Anand S, Yusuf S, Xie C, Pogue J, Eikelboom J, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med. 2007 Jul 19;357(3):217-27.

Reviewed last on: 5/13/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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