Research LettersLower-limb arterial disease
Section snippets
Epidemiology
Population surveys have reported a prevalence of intermittent claudication between 1% and 7% for men aged 50–75 years.1 The incidence of symptoms increases with age, from around 0·2% per year for men aged 35–45 years to more than 1% per year for men older than 65 years. Symptomatic peripheral arterial disease is two to five times more common in men than in women.1 Symptomless peripheral arterial disease is very common, with a prevalence on non-invasive testing of up to 25% in men older than 50
Investigation
General assessment of the cardiovascular system and identification of atherosclerosis risk factors is an important part of the first consultation of a patient with symptoms of peripheral arterial disease. History and clinical examination will usually confirm the diagnosis, although in patients with mixed disease (for example, symptoms of cauda equina compression with evidence of arterial disease on examination) non-invasive assessment may be required.
Treatment for intermittent claudication
Given the high prevalence of associated coronary and cerebrovascular disease, measures to reduce risk factors for atherosclerosis, such as cessation of smoking and control of serum lipids, are important.
Definition of critical ischaemia
The reliable prediction of imminent limb death has proved difficult; all presently suggested definitions are inaccurate in identifying patients likely to require amputation.11 Most definitions include the presence of severe pain at rest necessitating opioid analgesia, or ulceration or gangrene with a low ankle arterial pressure (<40–60 mm Hg).11 Wolfe and Wyatt30 have suggested two categories for patients with severe ischaemia. Patients with pain at rest and an ankle pressure greater than 40
Peripheral arterial disease research
Progression of atherosclerosis, thrombosis of critical lesions, and development of stenoses at the site of vascular intervention (restenosis after angioplasty and graft stenosis) all contribute to the poor outcome in patients with peripheral arterial disease. Pharmacological approaches have been successful in controlling thrombosis but have had limited effect on the progression of atherosclerosis or restenosis.46 Increased understanding of interactions between cells and signalling within cells
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2015, AtherosclerosisCitation Excerpt :Patients may develop symptoms of more advanced lower extremity ischaemia, including rest pain, lower limb ischaemic ulceration and gangrene, known collectively as critical limb ischaemia (CLI) [1]. PAD patients are prone to functional disability and amputation, and have an increased risk of cardiovascular events [1–4]. Approximately 30% of people aged over 70 years (∼202 million individuals worldwide) are affected by PAD [3].
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