Peripheral Arterial Disease

Peripheral arterial disease (PAD) is remarkably common in the United States, with an age-adjusted prevalence of 12-15%. PAD accounts for over 400,000 hospitalizations, 80,000 angioplasties, 110,000 surgical revascularizations, and 69,000 amputations annually. Of patients with PAD, 15-40% suffer from claudication, the sensation of lower extremity or buttock pain that limits exercising and is relieved by rest. Claudication affects 3-7% of the general population and one in five patients over age 75. Risk factors include diabetes (3-4 fold increase), smoking (3-4 fold increase), male gender, hypertension (2-3 fold increase), and hypercholesterolemia.

The presence of PAD reflects systemic atherosclerotic disease, with affected patients also potentially having disease in the carotid circulation, and in the coronary and renal arteries. The all-cause mortality risk in patients with PAD is increased 3-fold, with a 6-fold increase in cardiovascular mortality.

When treating patients with PAD, the ultimate goal is to minimize pain, improve functional quality of life, and decrease the rate of progression to critical ischemia. Treatment often begins with risk-factor modification, including aggressive attempts at smoking cessation; control of hypertension, diabetes and cholesterol; and implementing a structured exercise therapy program. Patients with stable, intermittent claudication are instructed to engage in short periods of walking intended to induce moderate intensity discomfort (about 30 minutes per day, 4-5 times per week), interspersed with brief rest periods. Exercise trials for PAD have shown a doubling to tripling of walking distance over controls with simple exercise. (1) Many patients can delay or avoid surgical intervention altogether through such programs, coupled with risk factor modification and best medical therapy.

Evaluation of PAD begins with simple ankle-arm indices in the office or at the bedside. Abnormal values, combined with clinical evidence of ischemic disease, lead to vascular laboratory evaluation with color flow ultrasound scanning. CT, MR or catheter angiography may be added if intervention is planned. Critically stenotic lesions can be treated with angioplasty, stenting, open bypass, or a combination of these modalities. Catheter-based, minimally invasive techniques are usually the first therapeutic choice, with operative bypass procedures held in reserve for more complex problems or complications.

Redwood Regional Vascular Associates are well trained and experienced in all aspects of evaluation and treatment of peripheral vascular disease. Many of the ultrasound, CT and MRI examinations can be performed on-site at our Sotoyome facility.

American Heart Association
Mayo Clinic
Society for Vascular Surgery - Leg Artery Disease Information

Reference:

  1. Gardner AW, Poehlman ET: Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA. 274(12):975-80, 1995