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Chapter Summary

This chapter discusses peripheral artery disease (PAD), focusing on risk factors, clinical assessment, classification, and management. The most common cause of PAD is atherosclerotic plaque formation in arteries of the lower extremities. Risk factors for PAD include age, diabetes, smoking, and kidney disease. Patients with PAD have increased risk for future cardiovascular events. Clinical manifestations of patients with PAD depend on location and severity of stenosis. Typical claudication is only present in a minority of patients with PAD; many patients present with vague leg symptoms. Other manifestations of PAD include acute limb ischemia (ALI) and chronic limb-threatening ischemia (CLTI). A systemic and comprehensive approach should be applied to the diagnosis and management of PAD. Diagnostic testing for suspected PAD and CTLI is key to guiding further assessment and revascularization management. The ankle-brachial index (ABI) is key to diagnosis of PAD, with use of exercise to reveal claudication in specific cases. Other testing modalities can be helpful in patients with normal ABIs but high clinical suspicion for PAD. Medical management is key for reduction in cardiovascular morbidity and mortality as well as preservation of limb function and survival from amputation. Acute arterial occlusion management for viable limbs should focus on revascularization and anticoagulation.

eFig 26-01 Chapter 26: Diagnosis and Management of Diseases of the Peripheral Arteries


Peripheral vascular diseases are a diverse set of processes that can affect the arteries, veins, and lymphatic circulations. This chapter will focus on peripheral artery disease (PAD), which is defined as any arterial disease (other than aneurysms) from the abdominal aorta to the feet and toes. A systemic and comprehensive approach will be applied to the diagnosis and management of PAD. We will focus on the most common cause of PAD: atherosclerosis. Nonatherosclerotic causes of PAD such as vasospastic diseases, inflammatory diseases, and entrapment syndromes are beyond the scope of this chapter.


The anatomic hallmark of PAD is atherosclerotic plaque formation in arteries of the lower extremities. PAD is the most common cause of lower extremity ischemia in Western societies.1 The Global Burden of Disease study estimated more than a 30% increase in deaths and disability related to PAD between 2005 and 2015.2,3 Although many patients are asymptomatic, the most common presentations are complaints of vague symptoms of leg dysfunction, with only 10% to 30% of individuals experiencing classic claudication (leg discomfort brought on by walking and relieved by standing for 2–5 minutes).4–6 Limb dysfunction significantly impacts the quality of life for those patients who suffer from PAD.7–10 Progression of leg symptoms to rest pain, ulceration, and gangrene further compounds PAD-associated morbidity and mortality.

Age, smoking, diabetes, and chronic kidney disease (CKD) are the strongest risk factors for ...

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