Peripheral Arterial Disease, Causes, Signs and Symptoms, Diagnosis and Treatment

Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain.[5][15] When narrowing occurs in the heart, it is called coronary artery disease, 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][16] The classic symptom is leg pain when walking which resolves with rest, 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][17] The most common underlying mechanism of peripheral artery disease is atherosclerosis, especially in individuals over 40 years old.[6][18] Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis.[5][17] 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.[19][20][18] In those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy improve outcomes.[11][12] Medications, including statins, ACE inhibitors, and cilostazol may also help.[12][21] Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease due to the increased risk of heart attacks.[18][22][23] Anticoagulants such as warfarin are not typically of benefit.[24] Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy.[10]

In 2015, about 155 million people had PAD worldwide.[13] It becomes more common with age.[25] 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.
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