Definition of peripheral arterial disease: not just a semantic problem (original) (raw)
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Peripheral arterial disease in general and diabetic population
Medical Journal of Malaysia, 2007
Peripheral arterial disease (PAD) is stenosis or occlusion of peripheral arterial vessels by atherosclerotic plaque. It may present as intermittent claudication, rest pain and impotence. PAD of the lower limbs is the third most important site of atherosclerotic disease after coronary heart disease and cerebrovascular disease. Increasing age, family history, smoking, hypertension, dyslipidemia and more decisively diabetes are significant risk factors. PAD is a clinical condition that has often been neglected, underdiagnosed, undertreated and has a serious outcome. It may lead to nonhealing wounds, gangrene and amputation of the lower limbs. Hence, early identification of patients at risk of PAD and timely referral to the vascular surgeon in severe cases is crucial.
Peripheral arterial disease -- a cardiovascular time bomb
The British Journal of Diabetes & Vascular Disease, 2007
P eripheral arterial disease (PAD) is a reliable marker of future vascular disease and is a substantial public health issue. In Europe and North America, 27 million people are estimated to have PAD, and in the UK around 100,000 people are diagnosed every year. People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK. The gravity of the problem has prompted the formation of professional bodies to address this situation through the development of national clinical guidelines. Indeed, with the focus of general practitioners' work covered by the quality and outcomes framework in the General Medical Services (GMS) contract, many consider that the inclusion of PAD in the GMS contract is critical to raising awareness and improving the management of PAD in primary care. Br J Diabetes Vasc Dis 2007;7:236-9
The Canadian journal of cardiology, 2005
This Consensus Conference has been supported by the Canadian Cardiovascular Society. The process is dynamic, with intentional structure that requires peer review and feedback from cardiovascular specialists across Canada. The writing and review panel encompassed a broad range of specialists caring for the patient with peripheral arterial disease (PAD). PAD is an often asymptomatic, underdiagnosed, under-recognized and undertreated condition. It is associated with significant morbidity and cardiac mortality. Until recently, little attention has focused on the evaluation and treatment of the disease process itself. The goal of the present paper is to ensure better treatment, to reduce both morbidity and mortality in the patient with vascular disease and, importantly, to serve as a guide to the busy clinician. Although the focus is PAD, there are chapters on thoracic and abdominal aortic disease, renal arterial disease and the evidence supporting management. Screening and diagnostic te...
Peripheral arterial disease: a high risk - but neglected - disease population
BMC cardiovascular disorders, 2005
Peripheral arterial disease (PAD) is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.
DS8-1 Case Study 8 ■ Peripheral Arterial Disease
Definition Peripheral arterial disease (PAD), also known as peripheral arterial occlusive disease and arte-riosclerosis obliterans, is a very common and serious condition in which cholesterol, scar tissue , and calcium (i.e., atherosclerosis) accumulate in peripheral arteries and decrease blood flow. Poor blood flow can injure nerves and other tissues. PAD is one of a group of vascular disorders characterized by the functional or structural narrowing of blood vessels external to the heart and brain and collectively known as peripheral vascular disease. Since the arteries of the lower extremities are a common site of involvement, PAD is often referred to in the medical literature as lower extremity occlusive disease. Prevalence PAD is an increasingly prevalent disease that is reaching epidemic proportions. An estimated 12-20% of Americans age 65 and older are affected. It has also been estimated that approximately 10 million people in the United States currently have symptomatic PAD. PAD can develop in anyone, but it is most common in men older than 50 years. The disease has no established racial predilection. Significance PAD has become a major public health issue and has the potential to cause not only loss of limb but also loss of life. Because the frequency of this condition is age-related, primary healthcare providers will be faced with increasing numbers of patients with PAD as the population ages. With the elderly population expected to increase 22% by the year 2040, PAD is also anticipated to have a major financial impact on the nation's healthcare system. The disease can be acutely life-threatening and often requires emergency intervention to minimize morbidity and mortality. In addition to serious complications such as severe leg pain and gangrene, people with PAD are also at significantly increased risk for heart disease, stroke, and aortic aneurysms from widespread atherosclerosis. PAD is a major direct cause of amputation today. T h i s s t u d y r e s o u r c e w a s s h a r e d v i a C o u r s e H e r o. c o m
Peripheral artery disease is associated with severe impairment of vascular function
Vascular Medicine, 2013
Patients with peripheral artery disease (PAD) have higher cardiovascular event rates than patients with established coronary artery disease (CAD) and abnormal endothelial function predicts cardiovascular risk in PAD and CAD. We investigated the hypothesis that PAD is associated with a greater degree of impairment in vascular function than CAD. We used several non-invasive tests to evaluate endothelial function in 1320 men and women with combined PAD and CAD (n = 198), PAD alone (n = 179), CAD alone (n = 466), or controls aged > 45 years without CAD or PAD (n = 477). Patients with PAD had lower brachial artery flow-mediated dilation (5.1 ± 3.9% PAD and CAD, 5.9 ± 4.4% PAD alone) compared to patients with CAD alone (7.0 ± 4.5%) and no PAD or CAD (8.1 ± 5.1%, p < 0.0001). In multivariable models adjusting for clinical covariates and the presence of CAD, PAD remained associated with lower flow-mediated dilation (p < 0.0001). PAD was associated also with lower nitroglycerin-mediated dilation and reactive hyperemia. Patients with both PAD and CAD had a lower digital pulse amplitude tonometry (PAT) ratio in unadjusted models but not in adjusted models. Flow-mediated dilation was modestly associated with PAT ratio in patients with atherosclerotic disease (r = 0.23, p < 0.0001) but not among control participants (r = 0.008, p = 0.93). Our findings indicate that patients with PAD have greater impairment of vasodilator function and are consistent with the possibility that endothelial dysfunction may contribute to adverse cardiovascular prognosis in PAD.
Beyond the Arteries in Peripheral Artery Disease
Internal Medicine, 2018
Objectives. This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients. Material and methods. The prospective study included consecutive PAD patients admitted to the 2nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017. Rezults. The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p<0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p<0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III. Conclusions. The fragment of the PhD study presented the psychological profile in the ...
Peripheral arterial disease: A growing problem for the internist
European Journal of Internal Medicine, 2009
The atherothrombotic conditions, coronary artery disease, cerebrovascular disease and peripheral arterial disease (PAD), together account for almost one-half of all deaths in Europe each year; however, perception of the specific risks associated with PAD is generally poor compared with its related conditions. PAD is not just a localised diseaseit has serious systemic effects, and affected individuals have a higher risk of serious cardiovascular sequelae or death within 1 year of diagnosis compared with those with coronary artery or cerebrovascular disease. PAD, which currently affects approximately 16% of the general population aged over 55 years, is increasing because of the population aging and the continuing rise in cardiovascular risk factors. The management of PAD is a multidisciplinary approach, and while this can have its advantages, it can also mean that responsibility for patient care is unclear. Globally, almost one-third of all patients with PAD are under internist care. Internists are ideally placed to identify patients at risk of PAD and initiate prompt risk factor management because of their role in the continued care of elderly patients and those with diabetes, hypertension, dyslipidaemia, and chronic renal disease. Multidisciplinary guidelines for the clinical management of PAD, based on consensus among international specialists in a number of fields, have been developed to create an informed, unified and proactive approach to the treatment of PAD. They stress the continuity of care, the use of office-based ankle-brachial index testing to aid early diagnosis, and prompt and aggressive risk factor management.